Healthcare Provider Details

I. General information

NPI: 1336239466
Provider Name (Legal Business Name): DAVID MARK PIETSCH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 SEASONS PKWY SUITE 104B
WOODBURY MN
55125-4392
US

IV. Provider business mailing address

8449 MARSH CREEK RD
WOODBURY MN
55125-3043
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-7800
  • Fax: 651-702-7804
Mailing address:
  • Phone: 651-702-7800
  • Fax: 651-702-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3581
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: