=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508032376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE PEARSON PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2008
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12805 HIGHWAY 55 STE 310
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55441-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-476-4770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12805 HIGHWAY 55 STE 310
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55441-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-476-4770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | BRUCE PEARSON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 763-476-4770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 003660
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------