=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003914409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. PAUL A HJORT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 05/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 W DIVISION ST STE 101
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56301-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-251-3450
-----------------------------------------------------
Fax | 320-203-7594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 W DIVISION ST STE 101
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56301-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-251-3450
-----------------------------------------------------
Fax | 320-203-7594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2656
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 848
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------