Healthcare Provider Details

I. General information

NPI: 1831190891
Provider Name (Legal Business Name): ROBERT A MCDONALD CHIROPRACTOR LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 MAIN ST S
SAUK CENTRE MN
56378-1651
US

IV. Provider business mailing address

1008 MAIN ST S
SAUK CENTRE MN
56378-1651
US

V. Phone/Fax

Practice location:
  • Phone: 320-352-2082
  • Fax:
Mailing address:
  • Phone: 320-352-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1463
License Number StateMN

VIII. Authorized Official

Name: DR. ROBERT ALLAN MCDONALD
Title or Position: OWNER
Credential: DC
Phone: 320-352-2082