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General NPI Number Information
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NPI Number | 1306074349
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Entity Type | Individual
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Provider Name | BRIAN MARK DEVITT D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 14033 COMMERCE AVE NE STE 300-401
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City | PRIOR LAKE
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State | MN
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Zip | 55372-1438
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Country | US
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Telephone | 763-694-1974
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Fax |
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Provider Business Mailing Address
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Address Line | 14033 COMMERCE AVE NE STE 300-401
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City | PRIOR LAKE
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State | MN
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Zip | 55372-1438
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Country | US
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Telephone | 763-694-1974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3842
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3842
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License Number State | MN
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