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General NPI Number Information
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NPI Number | 1265624555
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Entity Type | Organization
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Legal Business Name | OASIS CHIROPRACTIC PA
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 7424 E PT DOUGLAS RD S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016
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Country | US
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Telephone | 651-458-5565
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Fax | 651-458-5023
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Provider Business Mailing Address
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Address Line | 7424 E PT DOUGLAS RD S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016
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Country | US
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Telephone | 651-458-5565
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Fax | 651-458-5023
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | ALEXANDER WILLIAM SHEPPARD
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Credential | DC
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Telephone | 651-458-5565
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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 | 4316
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License Number State | MN
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