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General NPI Number Information
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NPI Number | 1144093667
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Entity Type | Organization
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Legal Business Name | PURE HEALTH MN LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 2059 RANDOLPH AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-1751
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Country | US
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Telephone | 612-345-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 2059 RANDOLPH AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-1751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID MANCINI
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Credential | DC
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Telephone | 612-597-1459
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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 |
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License Number State |
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