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General NPI Number Information
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NPI Number | 1366778243
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Entity Type | Organization
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Legal Business Name | COTTAGE GROVE CHIROPRACTIC CLINIC, PA
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 7702 80TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3194
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Country | US
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Telephone | 651-459-0066
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Fax | 651-459-8005
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Provider Business Mailing Address
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Address Line | 7702 80TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3194
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Country | US
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Telephone | 651-459-0066
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Fax | 651-459-8005
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN D DELCASTILLO
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Credential | DC
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Telephone | 651-459-0066
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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 | 1398
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License Number State | MN
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