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General NPI Number Information
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NPI Number | 1376064030
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Entity Type | Organization
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Legal Business Name | OKERLUND CHIROPRACTIC
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 1750 TOWER BLVD STE 203
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City | VICTORIA
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State | MN
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Zip | 55386-4566
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Country | US
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Telephone | 952-442-2409
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | VICTORIA
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State | MN
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Zip | 55386-0042
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Country | US
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Telephone | 952-442-2409
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYLER JAMES OKERLUND
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Credential | DC
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Telephone | 952-442-2409
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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 | 6362
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License Number State | MN
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