=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558512632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIELLE TREGO, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2008
-----------------------------------------------------
Last Update Date | 09/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 CRETIN AVE S
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55105-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-201-3420
-----------------------------------------------------
Fax | 651-304-1700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 423 FAIRVIEW AVE S
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55105-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-201-3420
-----------------------------------------------------
Fax | 651-304-1700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIELLE TREGO FINDEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 952-201-3420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 5115
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------