Healthcare Provider Details

I. General information

NPI: 1710965470
Provider Name (Legal Business Name): JOHN DAVID BELDE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HIGHWAY 25 S
MONTICELLO MN
55362-9306
US

IV. Provider business mailing address

PO BOX 717
MONTICELLO MN
55362-0717
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-4105
  • Fax: 763-295-9116
Mailing address:
  • Phone: 763-295-4105
  • Fax: 763-295-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2556
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: