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General NPI Number Information
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NPI Number | 1013096437
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Entity Type | Organization
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Legal Business Name | B C SHOES INC.
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 128 CENTRAL AVE N
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City | FARIBAULT
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State | MN
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Zip | 55021-5298
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Country | US
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Telephone | 507-334-7774
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Fax | 507-334-9256
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Provider Business Mailing Address
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Address Line | 128 CENTRAL AVE N
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City | FARIBAULT
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State | MN
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Zip | 55021-5298
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Country | US
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Telephone | 507-334-7774
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Fax | 507-334-9256
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. BRIAN D. BURKHARTZMEYER
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Credential | O.S.T., C. PED.
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Telephone | 507-334-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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