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General NPI Number Information
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NPI Number | 1417231440
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Entity Type | Organization
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Legal Business Name | DEVICH CHIROPRACTIC CENTER PA
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1510 8TH ST S
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City | VIRGINIA
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State | MN
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Zip | 55792-3346
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Country | US
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Telephone | 218-741-4010
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Fax | 218-741-0118
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Provider Business Mailing Address
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Address Line | 1510 8TH ST S
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City | VIRGINIA
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State | MN
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Zip | 55792-3346
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Country | US
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Telephone | 218-741-4010
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Fax | 218-741-0118
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS STEVEN DEVICH
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Credential | D.C.
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Telephone | 218-741-4010
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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 | 4971044
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License Number State | MN
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