Healthcare Provider Details

I. General information

NPI: 1720015191
Provider Name (Legal Business Name): CHRISTOPHER P MASSOGLIA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 TALMAGE CIR STE 216
VADNAIS HEIGHTS MN
55110
US

IV. Provider business mailing address

3640 TALMAGE CIR STE 216
VADNAIS HEIGHTS MN
55110-7100
US

V. Phone/Fax

Practice location:
  • Phone: 952-431-5330
  • Fax: 952-431-5334
Mailing address:
  • Phone: 952-431-5330
  • Fax: 952-432-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2728
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: