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General NPI Number Information
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NPI Number | 1033129861
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Entity Type | Organization
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Legal Business Name | WELL-ADJUSTED CHIROPRACTIC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2436 ALBERT ST N
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City | ROSEVILLE
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State | MN
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Zip | 55113-3158
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Country | US
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Telephone | 651-329-7679
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Fax |
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Provider Business Mailing Address
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Address Line | 2436 ALBERT ST N
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City | ROSEVILLE
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State | MN
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Zip | 55113-3158
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Country | US
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Telephone | 651-329-7679
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN H PEDERSON
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Credential | DC
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Telephone | 65133297679
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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 | 4194
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License Number State | MN
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