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General NPI Number Information
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NPI Number | 1699034850
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Entity Type | Organization
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Legal Business Name | PRINCETON BACK AND NECK CLINIC PA
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 209 RUM RIVER DR N SUITE 2
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City | PRINCETON
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State | MN
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Zip | 55371-1609
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Country | US
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Telephone | 763-631-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 209 RUM RIVER DR N SUITE 2
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City | PRINCETON
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State | MN
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Zip | 55371-1609
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Country | US
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Telephone | 763-631-2225
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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. STEVEN CRAIG VANHOOSER
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Credential | D.C.
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Telephone | 763-631-2225
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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 | 1677
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License Number State | MN
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