=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578700225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DULUTH NATURAL MEDICINE & CHIROPRACTIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2009
-----------------------------------------------------
Last Update Date | 01/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1731 LONDON RD
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55812-3846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-724-4525
-----------------------------------------------------
Fax | 218-728-0089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1731 LONDON RD
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55812-3846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-724-4525
-----------------------------------------------------
Fax | 218-728-0089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES/ CEO
-----------------------------------------------------
Name | DR. ROBB EVAN ANDERSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 218-724-4525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1808MN
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------