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General NPI Number Information
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NPI Number | 1467696120
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Entity Type | Organization
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Legal Business Name | DESIRED HEALTH CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/26/2009
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Last Update Date | 04/26/2009
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Provider Practice Location Address
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Address Line | 530 W MAIN ST SUITE 10
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City | ANOKA
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State | MN
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Zip | 55303-2063
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Country | US
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Telephone | 612-968-3385
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Fax |
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Provider Business Mailing Address
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Address Line | 530 W MAIN ST SUITE 10
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City | ANOKA
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State | MN
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Zip | 55303-2063
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Country | US
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Telephone | 612-968-3385
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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. DESIREE MARCELINE VAN BOGART
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Credential | D.C.
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Telephone | 612-968-3385
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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 | 3290217-2
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License Number State | MN
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