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General NPI Number Information
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NPI Number | 1356458582
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Entity Type | Organization
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Legal Business Name | DEHEN CHIROPRACTIC, LTD.
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1706 LOR RAY DR
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City | NORTH MANKATO
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State | MN
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Zip | 56003-1939
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Country | US
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Telephone | 507-388-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 LOR RAY DR
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City | NORTH MANKATO
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State | MN
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Zip | 56003-1939
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Country | US
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Telephone | 507-388-7744
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DAVID DEHEN
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Credential | D.C.
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Telephone | 507-388-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2374
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License Number State | MN
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