Healthcare Provider Details

I. General information

NPI: 1053613067
Provider Name (Legal Business Name): WARROAD CHIROPRACTIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 STATE AVE SW
WARROAD MN
56763-2621
US

IV. Provider business mailing address

PO BOX 636
WARROAD MN
56763-0636
US

V. Phone/Fax

Practice location:
  • Phone: 218-386-3112
  • Fax: 218-386-2028
Mailing address:
  • Phone: 218-386-3112
  • Fax: 218-386-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2515
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID VERWORN
Title or Position: OWNER
Credential: D.C.
Phone: 218-386-3112