Healthcare Provider Details

I. General information

NPI: 1447476734
Provider Name (Legal Business Name): ST CLOUD CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 33RD AVE N
SAINT CLOUD MN
56303-4846
US

IV. Provider business mailing address

437 33RD AVE N
SAINT CLOUD MN
56303-4846
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5599
  • Fax: 320-253-4585
Mailing address:
  • Phone: 320-252-5599
  • Fax: 320-253-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1313
License Number StateMN

VIII. Authorized Official

Name: DR. DENNIS ALAN WOGGON
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 320-252-5599