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General NPI Number Information
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NPI Number | 1386947869
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Entity Type | Organization
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Legal Business Name | SUMMIT CHIROPRACTIC AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 10904 57TH ST NE SUITE 107
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City | ALBERTVILLE
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State | MN
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Zip | 55301-4658
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Country | US
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Telephone | 763-515-6177
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Fax | 763-515-6199
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Provider Business Mailing Address
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Address Line | 10904 57TH ST NE SUITE 107
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City | ALBERTVILLE
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State | MN
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Zip | 55301-4658
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Country | US
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Telephone | 763-515-6177
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Fax | 763-515-6199
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GILES STIFTER
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Credential | D.C., C.C.W.P.
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Telephone | 763-515-6177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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