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General NPI Number Information
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NPI Number | 1447652367
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Entity Type | Organization
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Legal Business Name | GENTLE CARE CHIROPRACTIC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 23624 SAINT FRANCIS BLVD NW
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City | SAINT FRANCIS
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State | MN
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Zip | 55070-5500
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Country | US
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Telephone | 763-753-3126
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Fax |
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Provider Business Mailing Address
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Address Line | 23624 SAINT FRANCIS BLVD NW
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City | SAINT FRANCIS
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State | MN
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Zip | 55070-5500
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Country | US
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Telephone | 763-753-3126
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA RANDALL
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Credential | D.C.
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Telephone | 763-753-3126
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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 | 5108
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License Number State | MN
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