Healthcare Provider Details

I. General information

NPI: 1134359714
Provider Name (Legal Business Name): MEADOW AREA CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 2ND AVE. NE SUITE 100
GRAND MEADOW MN
55936
US

IV. Provider business mailing address

209 2ND AVE. NE P.O. BOX 508
GRAND MEADOW MN
55936
US

V. Phone/Fax

Practice location:
  • Phone: 507-754-4545
  • Fax: 507-754-4546
Mailing address:
  • Phone: 507-754-4545
  • Fax: 507-754-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5199
License Number StateMN

VIII. Authorized Official

Name: DR. DILLON CARTER DENISEN
Title or Position: OWNER
Credential: D.C.
Phone: 507-754-4545