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General NPI Number Information
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NPI Number | 1356633275
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Entity Type | Individual
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Provider Name | ROBYN LOUISE BROSTROM-MARTIN D.C
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Gender | Female
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 854 W 78TH ST SUITE 204
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City | CHANHASSEN
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State | MN
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Zip | 55317-9506
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Country | US
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Telephone | 952-474-1949
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Fax | 952-474-1959
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Provider Business Mailing Address
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Address Line | 18924 LAKE DR E
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City | CHANHASSEN
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State | MN
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Zip | 55317-9348
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Country | US
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Telephone | 952-474-1949
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Fax | 952-474-1959
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5516
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License Number State | MN
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