Healthcare Provider Details

I. General information

NPI: 1215076849
Provider Name (Legal Business Name): BARBARA LYNN FAGAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 5TH ST SE 312
MINNEAPOLIS MN
55414-4504
US

IV. Provider business mailing address

1313 5TH ST SE 312
MINNEAPOLIS MN
55414-4504
US

V. Phone/Fax

Practice location:
  • Phone: 612-379-1808
  • Fax: 612-379-1908
Mailing address:
  • Phone: 612-379-1808
  • Fax: 612-379-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2874
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: