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General NPI Number Information
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NPI Number | 1083120372
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Entity Type | Organization
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Legal Business Name | MOSENG CHIROPRACTIC PLLP
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 01/02/2018
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Provider Practice Location Address
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Address Line | 525 LEGION DR STE 1
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City | MONTEVIDEO
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State | MN
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Zip | 56265-1723
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Country | US
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Telephone | 320-269-7135
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Fax | 320-269-7583
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Provider Business Mailing Address
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Address Line | 525 LEGION DR STE 1
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City | MONTEVIDEO
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State | MN
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Zip | 56265-1723
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Country | US
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Telephone | 320-269-7135
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Fax | 320-269-7583
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Authorized Official
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Title or Position | OWNER
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Name | DR. BROCK J MADSEN
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Credential | DC
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Telephone | 320-269-7135
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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 | 6138
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2209
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License Number State | MN
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