Healthcare Provider Details

I. General information

NPI: 1710027990
Provider Name (Legal Business Name): CHIROPRACTIC SPECIALISTS OF WATERTOWN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 LEWIS AVE S
WATERTOWN MN
55388-4535
US

IV. Provider business mailing address

PO BOX 39
WATERTOWN MN
55388-0039
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-2070
  • Fax: 952-955-2370
Mailing address:
  • Phone: 952-955-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4378
License Number StateMN

VIII. Authorized Official

Name: DR. HEATHER M JARVIS
Title or Position: DOCTOR
Credential: DC
Phone: 952-955-2070