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General NPI Number Information
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NPI Number | 1699837708
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Entity Type | Organization
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Legal Business Name | MCR, IRIS PARK CHIROPRACTIC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1828 S CEDAR AVE # 2
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City | OWATONNA
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State | MN
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Zip | 55060-4204
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Country | US
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Telephone | 507-451-9155
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Fax |
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Provider Business Mailing Address
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Address Line | 1828 S CEDAR AVE # 2
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City | OWATONNA
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State | MN
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Zip | 55060-4204
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Country | US
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Telephone | 507-451-9155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK JAMES COCHRAN
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Credential | DC
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Telephone | 507-451-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1551
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License Number State | MN
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