Healthcare Provider Details

I. General information

NPI: 1801068556
Provider Name (Legal Business Name): BRENT ALLAN STROMGREN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17787 KENWOOD TRL
LAKEVILLE MN
55044-9493
US

IV. Provider business mailing address

17787 KENWOOD TRL
LAKEVILLE MN
55044-9493
US

V. Phone/Fax

Practice location:
  • Phone: 952-435-3345
  • Fax: 952-435-8895
Mailing address:
  • Phone: 952-435-3345
  • Fax: 952-435-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5111
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: