Healthcare Provider Details

I. General information

NPI: 1720787583
Provider Name (Legal Business Name): CLEY JAMES CHARLSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 CHIPPENDALE AVE W STE 7
FARMINGTON MN
55024-8206
US

IV. Provider business mailing address

20700 CHIPPENDALE AVE W STE 7
FARMINGTON MN
55024-8206
US

V. Phone/Fax

Practice location:
  • Phone: 651-460-9449
  • Fax: 612-326-9581
Mailing address:
  • Phone: 651-460-9449
  • Fax: 612-326-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7086
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: