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General NPI Number Information
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NPI Number | 1730333113
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Entity Type | Organization
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Legal Business Name | OWATONNA NATURAL HEALTH CLINIC INC.
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 152 E PEARL ST
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City | OWATONNA
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State | MN
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Zip | 55060-2420
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Country | US
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Telephone | 507-451-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 WHITETAIL RUN PL NE
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City | OWATONNA
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State | MN
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Zip | 55060-6249
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Country | US
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Telephone | 507-455-2424
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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. JODI LYNN SAMPSON
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Credential | D.C.
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Telephone | 507-455-2424
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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 | 4243
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License Number State | MN
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