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General NPI Number Information
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NPI Number | 1700026762
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Entity Type | Organization
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Legal Business Name | SAWTOOTH CHIROPRACTIC PC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 501 W 5TH ST
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City | GRAND MARAIS
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State | MN
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Zip | 55604
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Country | US
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Telephone | 218-387-2383
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Fax | 218-387-2383
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | GRAND MARAIS
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State | MN
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Zip | 55604-0158
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Country | US
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Telephone | 218-387-2383
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Fax | 218-387-2383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MALIN ELISABETH ASEBY-GESCH
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Credential | DC
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Telephone | 218-387-2383
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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 | 723
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License Number State | MN
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