Healthcare Provider Details

I. General information

NPI: 1972524981
Provider Name (Legal Business Name): STEVEN NICHOLAS FIDELDY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NE 11TH AVE SUITE A
GRAND RAPIDS MN
55744-3286
US

IV. Provider business mailing address

118 NE 11TH AVE SUITE A
GRAND RAPIDS MN
55744-3286
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3603
  • Fax: 218-326-3606
Mailing address:
  • Phone: 218-326-3603
  • Fax: 218-326-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4175
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: