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General NPI Number Information
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NPI Number | 1700073657
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC AND WELLNESS, P.A.
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 17502 DODD BLVD
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City | LAKEVILLE
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State | MN
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Zip | 55044
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Country | US
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Telephone | 952-431-7400
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Fax | 952-431-7274
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Provider Business Mailing Address
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Address Line | 17502 DODD BLVD.
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City | LAKEVILLE
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State | MN
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Zip | 55044
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Country | US
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Telephone | 952-431-7400
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Fax | 952-431-7274
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Authorized Official
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Title or Position | PRESIDENT
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Name | DUANE J OLSON
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Credential | D.C.
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Telephone | 952-431-7400
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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 | 001343
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5500
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License Number State | MN
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