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General NPI Number Information
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NPI Number | 1457012544
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Entity Type | Individual
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Provider Name | AUSTIN DUANE AUDETTE DC
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Gender | Male
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Dates
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Enumeration Date | 01/01/2022
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Last Update Date | 01/01/2022
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Provider Practice Location Address
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Address Line | 2921 S FRONTAGE RD STE 3
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City | MOORHEAD
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State | MN
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Zip | 56560-2571
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Country | US
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Telephone | 218-233-8545
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Fax |
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Provider Business Mailing Address
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Address Line | 1521 1ST AVE N APT 405
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City | MOORHEAD
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State | MN
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Zip | 56560-2265
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Country | US
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Telephone | 218-688-0884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6924
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License Number State | MN
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