Healthcare Provider Details

I. General information

NPI: 1063519627
Provider Name (Legal Business Name): METTLER FAMILY CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BROADWAY ST
SPRING VALLEY MN
55975-1227
US

IV. Provider business mailing address

105 S BROADWAY ST
SPRING VALLEY MN
55975-1227
US

V. Phone/Fax

Practice location:
  • Phone: 507-346-1077
  • Fax: 507-346-7117
Mailing address:
  • Phone: 507-346-1077
  • Fax: 507-346-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1629386-2
License Number StateMN

VIII. Authorized Official

Name: DR. WILLIAM CECIL METTLER
Title or Position: SECRATARY - TREASURER
Credential: D.C.
Phone: 507-346-1077