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General NPI Number Information
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NPI Number | 1164614202
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Entity Type | Organization
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Legal Business Name | CROW RIVER ENTERPRISES
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 1507 JEFFERSON ST SE SUITE 1
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City | HUTCHINSON
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State | MN
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Zip | 55350
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Country | US
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Telephone | 320-587-2215
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 JEFFERSON ST SE SUITE 1
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City | HUTCHINSON
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State | MN
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Zip | 55350
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Country | US
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Telephone | 320-587-2215
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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 | DR. RANDY JOHAN JURGENSON
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Credential | DC
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Telephone | 320-587-2215
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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 | 3383
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License Number State | MN
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