Healthcare Provider Details

I. General information

NPI: 1578541843
Provider Name (Legal Business Name): MARY BETH MINSER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PARK AVE S SUITE 101
SAINT CLOUD MN
56301-3779
US

IV. Provider business mailing address

203 PARK AVE S SUITE 101
SAINT CLOUD MN
56301-3779
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-5650
  • Fax: 320-253-9222
Mailing address:
  • Phone: 320-253-5650
  • Fax: 320-253-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number106
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2734
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: