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General NPI Number Information
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NPI Number | 1598496176
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Entity Type | Organization
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Legal Business Name | POLARIS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1539 E 7TH ST
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City | MONTICELLO
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State | MN
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Zip | 55362-4674
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Country | US
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Telephone | 763-296-4340
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Fax |
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Provider Business Mailing Address
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Address Line | 1539 E 7TH ST
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City | MONTICELLO
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State | MN
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Zip | 55362-4674
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Country | US
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Telephone | 763-296-4340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CODY DESSELLIER
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Credential | DC
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Telephone | 763-296-4340
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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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