Healthcare Provider Details

I. General information

NPI: 1376689687
Provider Name (Legal Business Name): WILLIAM THOMAS NORLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E LAKE ST
MINNEAPOLIS MN
55406-2339
US

IV. Provider business mailing address

4401 E LAKE ST
MINNEAPOLIS MN
55406-2339
US

V. Phone/Fax

Practice location:
  • Phone: 612-724-4647
  • Fax: 612-729-3606
Mailing address:
  • Phone: 612-724-4647
  • Fax: 612-729-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number001817-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: