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General NPI Number Information
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NPI Number | 1588600043
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Entity Type | Organization
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Legal Business Name | IHS MIDWEST PC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 211 HIGHWAY 25 S
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City | MONTICELLO
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State | MN
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Zip | 55362-9306
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Country | US
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Telephone | 651-334-1290
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Fax | 763-295-9116
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Provider Business Mailing Address
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Address Line | 450 FORD RD UNIT 101
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-1058
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Country | US
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Telephone | 651-334-1290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER PAUL MASSOGLIA SR.
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Credential | DC
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Telephone | 651-334-1290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 | MN
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