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General NPI Number Information
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NPI Number | 1134678410
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Entity Type | Organization
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Legal Business Name | NORTHERN CHIROPRACTIC AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 730 APOLLO DR SUITE 120
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City | LINO LAKES
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State | MN
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Zip | 55014-3037
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Country | US
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Telephone | 651-797-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 730 APOLLO DR SUITE 120
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City | LINO LAKES
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State | MN
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Zip | 55014-3037
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Country | US
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Telephone | 651-797-3756
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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. TYLER PAUL HANSON
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Credential | D.C.
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Telephone | 651-797-3756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 6001
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License Number State | MN
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