Healthcare Provider Details

I. General information

NPI: 1982873337
Provider Name (Legal Business Name): ST. CHARLES FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E 6TH ST
SAINT CHARLES MN
55972-1403
US

IV. Provider business mailing address

213 E 6TH ST
SAINT CHARLES MN
55972-1403
US

V. Phone/Fax

Practice location:
  • Phone: 507-932-5696
  • Fax:
Mailing address:
  • Phone: 507-932-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4958
License Number StateMN

VIII. Authorized Official

Name: DR. ERIC DOUGLAS OMDAHL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 507-932-5696