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General NPI Number Information
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NPI Number | 1053656157
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Entity Type | Organization
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Legal Business Name | HAUCK CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 215 RAMSEY ST
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City | HASTINGS
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State | MN
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Zip | 55033-1220
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Country | US
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Telephone | 414-248-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 HODGSON RD
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City | SHOREVIEW
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State | MN
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Zip | 55126-4671
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Country | US
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Telephone | 414-248-0011
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. EMILY JOY HAUCK
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Credential | D.C.
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Telephone | 414-248-0011
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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 | 5691
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License Number State | MN
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