Healthcare Provider Details

I. General information

NPI: 1639930894
Provider Name (Legal Business Name): BROOKLIN BATES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 215
NORWOOD YOUNG AMERICA MN
55368-0215
US

IV. Provider business mailing address

PO BOX 215
CHANHASSEN MN
55317-0215
US

V. Phone/Fax

Practice location:
  • Phone: 952-484-4265
  • Fax: 952-467-9104
Mailing address:
  • Phone: 952-467-2505
  • Fax: 952-467-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7174
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: