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General NPI Number Information
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NPI Number | 1477762110
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH OF WEST ST PAUL
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 1089 ROBERT ST S
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-1456
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Country | US
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Telephone | 651-457-5435
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Fax | 651-457-8091
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Provider Business Mailing Address
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Address Line | 1089 ROBERT ST S
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-1456
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Country | US
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Telephone | 651-457-5435
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Fax | 651-457-8091
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Authorized Official
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Title or Position | OWNER
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Name | LARRY L ESTEBO
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Credential | DC
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Telephone | 651-379-1842
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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 |
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License Number State |
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