Healthcare Provider Details

I. General information

NPI: 1528318474
Provider Name (Legal Business Name): TRISTA ELIZABETH SPOLARICH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 VINEWOOD LN N
PLYMOUTH MN
55441-1155
US

IV. Provider business mailing address

2920 DEAN PKWY APT 311
MINNEAPOLIS MN
55416-4455
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-9236
  • Fax:
Mailing address:
  • Phone: 218-851-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5702
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: