Healthcare Provider Details

I. General information

NPI: 1831194281
Provider Name (Legal Business Name): MARK DAVID DEHEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 LOR RAY DR
NORTH MANKATO MN
56003-1939
US

IV. Provider business mailing address

1706 LOR RAY DR
NORTH MANKATO MN
56003-1939
US

V. Phone/Fax

Practice location:
  • Phone: 507-388-7744
  • Fax: 507-388-8001
Mailing address:
  • Phone: 507-388-7744
  • Fax: 507-388-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2374
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: