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General NPI Number Information
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NPI Number | 1265148480
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Entity Type | Organization
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Legal Business Name | LAKE REGION HEALTHCARE CORPORATION
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 301 E LINCOLN AVE
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City | FERGUS FALLS
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State | MN
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Zip | 56537-2238
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Country | US
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Telephone | 218-736-3972
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Fax |
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Provider Business Mailing Address
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Address Line | 712 S CASCADE ST
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City | FERGUS FALLS
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State | MN
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Zip | 56537-2913
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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 | CEO
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Name | KENT MATTSON
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Credential |
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Telephone | 218-736-8090
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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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