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General NPI Number Information
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NPI Number | 1699321638
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Entity Type | Organization
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Legal Business Name | PIVOTAL CHIROPRACTIC & WELLNESS PLLC
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1600 MADISON AVE STE 112
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City | MANKATO
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State | MN
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Zip | 56001-5470
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Country | US
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Telephone | 507-401-2650
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 MADISON AVE STE 112
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City | MANKATO
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State | MN
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Zip | 56001-5470
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Country | US
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Telephone | 507-401-2650
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Fax | 507-403-2650
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Authorized Official
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Title or Position | OWNER
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Name | DR. TUCKER J BAUMANN
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Credential | D.C.
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Telephone | 507-401-2650
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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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