Healthcare Provider Details

I. General information

NPI: 1518091149
Provider Name (Legal Business Name): APEX CHIROPRACTIC OF ROGERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13635 NORTHDALE BLVD
ROGERS MN
55374-2142
US

IV. Provider business mailing address

4221 WINNETKA AVE N
NEW HOPE MN
55428
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-1105
  • Fax:
Mailing address:
  • Phone: 763-533-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3596
License Number StateMN

VIII. Authorized Official

Name: DR. RICHARD PAUL WILLIAMS
Title or Position: OWNER
Credential:
Phone: 763-533-0654