Healthcare Provider Details

I. General information

NPI: 1003038241
Provider Name (Legal Business Name): GARNETT CHIROPRACTIC & REHAB CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 SELBY AVE.
ST. PAUL MN
55104
US

IV. Provider business mailing address

876 SELBY AVE.
ST. PAUL MN
55104
US

V. Phone/Fax

Practice location:
  • Phone: 651-225-4421
  • Fax: 651-222-4672
Mailing address:
  • Phone: 651-225-4421
  • Fax: 651-222-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4384
License Number StateMN

VIII. Authorized Official

Name: DR. MARK ANTHONY GARNETT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 651-225-4421