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General NPI Number Information
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NPI Number | 1396221966
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Entity Type | Organization
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Legal Business Name | NORTHERN HOPE FUNCTIONAL NEUROLOGY AND CHIROPRACTIC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 25503 MAIN ST
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City | NISSWA
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State | MN
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Zip | 56468-5000
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Country | US
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Telephone | 605-670-2898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | NISSWA
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State | MN
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Zip | 56468-0505
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Country | US
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Telephone | 605-670-2898
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TONY J GRABER
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Credential | DC
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Telephone | 605-670-2898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 4970
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License Number State | MN
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