Healthcare Provider Details

I. General information

NPI: 1245272186
Provider Name (Legal Business Name): WILLIAM C HARRALSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 UTAH AVE S SUITE 200
SAINT LOUIS PARK MN
55426-3671
US

IV. Provider business mailing address

3015 UTAH AVE S SUITE 200
SAINT LOUIS PARK MN
55426-3671
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-1121
  • Fax: 952-945-9635
Mailing address:
  • Phone: 952-933-1121
  • Fax: 952-945-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number3746
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: