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General NPI Number Information
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NPI Number | 1093106122
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Entity Type | Organization
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Legal Business Name | ARDENVIEW
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 3434 LEXINGTON AVE N
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City | SHOREVIEW
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State | MN
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Zip | 55126-8069
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Country | US
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Telephone | 651-447-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 3434 LEXINGTON AVE N
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City | SHOREVIEW
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State | MN
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Zip | 55126-8069
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Country | US
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Telephone | 651-447-2468
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MICHAEL HEAD
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Credential |
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Telephone | 651-447-2468
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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 | 3281
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License Number State | MN
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