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General NPI Number Information
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NPI Number | 1003185760
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Entity Type | Organization
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Legal Business Name | ALTO CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 12/23/2011
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Provider Practice Location Address
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Address Line | 10880 175TH CT W STE 120
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City | LAKEVILLE
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State | MN
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Zip | 55044-7493
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Country | US
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Telephone | 952-693-8798
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Fax |
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Provider Business Mailing Address
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Address Line | 10880 175TH CT W STE 120
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City | LAKEVILLE
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State | MN
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Zip | 55044-7493
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Country | US
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Telephone | 952-693-8798
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Fax |
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Authorized Official
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Title or Position | DC/OWNER
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Name | KRYSTAL MARIE ALTO
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Credential | DC
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Telephone | 952-693-8798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5184
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License Number State | MN
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