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General NPI Number Information
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NPI Number | 1598136830
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Entity Type | Organization
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Legal Business Name | WACONIA FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 9384 OAK AVE STE A
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City | WACONIA
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State | MN
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Zip | 55387-9422
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Country | US
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Telephone | 952-442-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 1951 FISCHER DR
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City | WACONIA
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State | MN
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Zip | 55387-7500
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Country | US
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Telephone | 612-868-9375
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR/CHIROPRACTOR
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Name | DR. EMILY BOTTOMS
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Credential | DC
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Telephone | 612-868-9375
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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 | 5476
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License Number State | MN
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