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General NPI Number Information
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NPI Number | 1588150049
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Entity Type | Organization
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Legal Business Name | OUT AND ABOUT CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 1484 CLARMAR AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-1608
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Country | US
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Telephone | 612-331-9999
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Fax | 651-330-0826
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Provider Business Mailing Address
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Address Line | 1484 CLARMAR AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-1608
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Country | US
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Telephone | 612-331-9999
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Fax | 651-330-0826
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ROBERT STAEHELI
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Credential | DC
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Telephone | 612-840-2517
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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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