Healthcare Provider Details

I. General information

NPI: 1366600629
Provider Name (Legal Business Name): MEDELBERG FAMILY CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 COUNTY ROAD 75 SUITE 103
SAINT JOSEPH MN
56374-8648
US

IV. Provider business mailing address

710 COUNTY ROAD 75 SUITE 103
SAINT JOSEPH MN
56374-8648
US

V. Phone/Fax

Practice location:
  • Phone: 320-271-1800
  • Fax: 320-271-1808
Mailing address:
  • Phone: 320-271-1800
  • Fax: 320-271-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3062
License Number StateMN

VIII. Authorized Official

Name: DR. ERIC JOSEPH MEDELBERG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 320-271-1800