Healthcare Provider Details

I. General information

NPI: 1659397354
Provider Name (Legal Business Name): NICHOLAS JAMES RAPP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15170 CHIPPENDALE AVE W STE 200
ROSEMOUNT MN
55068-2770
US

IV. Provider business mailing address

15170 CHIPPENDALE AVE W STE 200
ROSEMOUNT MN
55068-2770
US

V. Phone/Fax

Practice location:
  • Phone: 612-840-0374
  • Fax:
Mailing address:
  • Phone: 612-840-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4788
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: