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General NPI Number Information
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NPI Number | 1689733362
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Entity Type | Organization
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Legal Business Name | MILLE LACS CHIROPRACTICS
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 1010 5TH ST SE
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City | MILACA
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State | MN
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Zip | 56353-1300
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Country | US
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Telephone | 320-983-2728
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Fax | 320-983-2725
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Provider Business Mailing Address
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Address Line | PO BOX 294
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City | MILACA
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State | MN
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Zip | 56353-0294
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Country | US
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Telephone | 320-983-2728
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Fax | 320-983-2725
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY BERNARD HASS
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Credential | DC
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Telephone | 320-983-2728
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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 | 2280
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License Number State | MN
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