Healthcare Provider Details

I. General information

NPI: 1073749842
Provider Name (Legal Business Name): COMPLETE CHIROPRACTIC CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 06/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 4TH AVE NE # 3
WAITE PARK MN
56387-1236
US

IV. Provider business mailing address

304 4TH AVE NE # 3
WAITE PARK MN
56387-1236
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-0766
  • Fax: 320-251-8295
Mailing address:
  • Phone: 320-251-0766
  • Fax: 320-251-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1413
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1413
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1413
License Number StateMN

VIII. Authorized Official

Name: DR. DARRELL KENT METCALF
Title or Position: OWNER
Credential: D.C.
Phone: 320-251-0766