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General NPI Number Information
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NPI Number | 1316127384
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Entity Type | Organization
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Legal Business Name | VERDAN PA
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 13060 CENTRAL AVE NE SUITE 100
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City | BLAINE
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State | MN
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Zip | 55434-4149
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Country | US
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Telephone | 763-566-8023
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Fax | 763-566-0630
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Provider Business Mailing Address
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Address Line | 13060 CENTRAL AVE NE SUITE 100
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City | BLAINE
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State | MN
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Zip | 55434-4149
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Country | US
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Telephone | 763-566-8023
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Fax | 763-566-0630
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Authorized Official
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Title or Position | OFFICE MGR.
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Name | MRS. TONI MARIE DANIELSON
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Credential |
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Telephone | 763-566-8023
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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 | 4619
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License Number State | MN
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