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General NPI Number Information
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NPI Number | 1538218284
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Entity Type | Organization
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Legal Business Name | MAHTOMEDI NATURAL CARE CENTER
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 1526 MAHTOMEDI AVE
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City | MAHTOMEDI
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State | MN
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Zip | 55115
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Country | US
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Telephone | 651-407-0802
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Fax | 651-407-0812
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Provider Business Mailing Address
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Address Line | 1526 MAHTOMEDI AVE
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City | MAHTOMEDI
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State | MN
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Zip | 55115
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Country | US
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Telephone | 651-407-0802
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Fax | 651-407-0812
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Authorized Official
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Title or Position | DR. GINA FIALA
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Name | DR. GINA FIALA
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Credential |
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Telephone | 651-407-0802
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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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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | MN4887
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License Number State | MN
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