Healthcare Provider Details

I. General information

NPI: 1255060141
Provider Name (Legal Business Name): NORTHBOUND CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 MEADOW LN
MAPLE PLAIN MN
55359-9531
US

IV. Provider business mailing address

1532 MEADOW LN
MAPLE PLAIN MN
55359-9531
US

V. Phone/Fax

Practice location:
  • Phone: 906-369-0905
  • Fax:
Mailing address:
  • Phone: 906-369-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS G CARLSON
Title or Position: OWNER, CHIROPRACTOR
Credential: DC
Phone: 906-369-0905