Healthcare Provider Details
I. General information
NPI: 1073706610
Provider Name (Legal Business Name): ERIC TIMOTHY SAUGEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
211 S MAIN ST
LE SUEUR MN
56058-1912
US
IV. Provider business mailing address
211 S MAIN ST
LE SUEUR MN
56058-1912
US
V. Phone/Fax
- Phone: 507-665-6249
- Fax: 507-665-6240
- Phone: 507-665-6249
- Fax: 507-665-6240
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | 2025 |
| License Number State | MN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: