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General NPI Number Information
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NPI Number | 1013100395
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Entity Type | Organization
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Legal Business Name | NORTHWOODS SPINE INSTSITUTE, PA
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 5524 W BROADWAY AVE
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City | CRYSTAL
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State | MN
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Zip | 55428-3508
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Country | US
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Telephone | 763-533-7700
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Fax | 763-533-6670
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Provider Business Mailing Address
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Address Line | 5524 W BROADWAY AVE
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City | CRYSTAL
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State | MN
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Zip | 55428-3508
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Country | US
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Telephone | 763-533-7700
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Fax | 763-533-6670
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Authorized Official
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Title or Position | PRESIDENT/DOCTOR
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Name | DR. GARY LEE HAHN JR.
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Credential | D.C.
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Telephone | 763-533-7700
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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 | 4522
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License Number State | MN
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