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General NPI Number Information
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NPI Number | 1336505551
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Entity Type | Organization
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Legal Business Name | HASTINGS SPORT AND SPINE LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1806 VERMILLION ST STE A
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City | HASTINGS
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State | MN
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Zip | 55033-3605
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Country | US
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Telephone | 563-449-6651
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Fax | 651-382-1661
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Provider Business Mailing Address
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Address Line | 1806 VERMILLION ST STE A
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City | HASTINGS
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State | MN
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Zip | 55033-3605
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Country | US
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Telephone | 510-409-2056
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Fax | 651-382-1661
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA RAY GEIDEL
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Credential | DC
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Telephone | 651-409-2056
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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 | 6166
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License Number State | MN
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