Healthcare Provider Details

I. General information

NPI: 1922123470
Provider Name (Legal Business Name): CORCORAN HAMEL CHIROPRACTIC , P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20010 75TH AVE N
CORCORAN MN
55340-9459
US

IV. Provider business mailing address

PO BOX 114
HAMEL MN
55340-0114
US

V. Phone/Fax

Practice location:
  • Phone: 763-416-4878
  • Fax:
Mailing address:
  • Phone: 763-416-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1424
License Number StateMN

VIII. Authorized Official

Name: DR. JAMES P. SEIM
Title or Position: PRESIDENT
Credential: DC, DACBN
Phone: 763-416-4878