Healthcare Provider Details

I. General information

NPI: 1083708705
Provider Name (Legal Business Name): JEFFREY W FALK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S OAK AVE SUITE 4
OWATONNA MN
55060-3900
US

IV. Provider business mailing address

2060 RASPBERRY RIDGE PL NE
OWATONNA MN
55060-6245
US

V. Phone/Fax

Practice location:
  • Phone: 507-455-0199
  • Fax:
Mailing address:
  • Phone: 507-451-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1218
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: