Healthcare Provider Details

I. General information

NPI: 1164564159
Provider Name (Legal Business Name): DAVID ALAN VERWORN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 STATE AVE S
WARROAD MN
56763
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:
Title or Position:
Credential:
Phone: