Healthcare Provider Details

I. General information

NPI: 1356683114
Provider Name (Legal Business Name): ERIC MICHAEL OLTMANNS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 COUNTY ROAD 120 STE B
SAINT CLOUD MN
56303-4886
US

IV. Provider business mailing address

251 COUNTY ROAD 120
SAINT CLOUD MN
56303-4886
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-3711
  • Fax: 320-240-0608
Mailing address:
  • Phone: 320-252-3711
  • Fax: 320-240-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5798
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: