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General NPI Number Information
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NPI Number | 1407125099
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Entity Type | Organization
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Legal Business Name | SIMPLY CHIROPRACTIC CENTER, P.A.
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 4886 HIGHWAY 61 N SUITE 201
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-2857
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Country | US
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Telephone | 651-762-4757
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Fax |
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Provider Business Mailing Address
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Address Line | 4886 HIGHWAY 61 N SUITE 201
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-2857
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Country | US
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Telephone | 651-762-4757
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JILL MARIE FRIEDRICHS
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Credential |
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Telephone | 651-762-4757
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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 | 5081
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License Number State | MN
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