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General NPI Number Information
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NPI Number | 1376260810
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Entity Type | Individual
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Provider Name | COURTNEY BLIESE DC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 7610 LYNDALE AVE S STE 600
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City | RICHFIELD
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State | MN
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Zip | 55423-4167
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Country | US
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Telephone | 612-545-5672
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Fax |
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Provider Business Mailing Address
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Address Line | 2053 23 3/16 AVE
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City | RICE LAKE
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State | WI
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Zip | 54868-9705
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Country | US
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Telephone | 715-651-8754
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Fax |
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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 | 7023
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License Number State | MN
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