Healthcare Provider Details

I. General information

NPI: 1700026762
Provider Name (Legal Business Name): SAWTOOTH CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 5TH ST
GRAND MARAIS MN
55604
US

IV. Provider business mailing address

PO BOX 158
GRAND MARAIS MN
55604-0158
US

V. Phone/Fax

Practice location:
  • Phone: 218-387-2383
  • Fax: 218-387-2383
Mailing address:
  • Phone: 218-387-2383
  • Fax: 218-387-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number723
License Number StateMN

VIII. Authorized Official

Name: DR. MALIN ELISABETH ASEBY-GESCH
Title or Position: PRESIDENT
Credential: DC
Phone: 218-387-2383