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General NPI Number Information
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NPI Number | 1538481734
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC OF SHAKOPEE, P.A.
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 1221 4TH AVE E SUITE 120
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City | SHAKOPEE
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State | MN
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Zip | 55379-1681
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Country | US
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Telephone | 952-445-0679
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Fax | 952-445-6979
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Provider Business Mailing Address
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Address Line | 1221 4TH AVE E SUITE 120
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City | SHAKOPEE
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State | MN
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Zip | 55379-1681
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Country | US
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Telephone | 952-445-0679
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Fax | 952-445-6979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN LESLIE HARDER
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Credential | D.C.
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Telephone | 952-445-0679
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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 | 3128
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License Number State | MN
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