Healthcare Provider Details

I. General information

NPI: 1730333113
Provider Name (Legal Business Name): OWATONNA NATURAL HEALTH CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 E PEARL ST
OWATONNA MN
55060-2420
US

IV. Provider business mailing address

1930 WHITETAIL RUN PL NE
OWATONNA MN
55060-6249
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-1691
  • Fax:
Mailing address:
  • Phone: 507-455-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4243
License Number StateMN

VIII. Authorized Official

Name: DR. JODI LYNN SAMPSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 507-455-2424