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General NPI Number Information
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NPI Number | 1740555143
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Entity Type | Organization
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Legal Business Name | OVERSTAD CHIROPRACTIC,P.A.
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 1425 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-5386
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Country | US
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Telephone | 612-802-2580
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Fax | 763-755-4600
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Provider Business Mailing Address
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Address Line | 1425 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-5386
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Country | US
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Telephone | 612-802-2580
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBIN RACHEL HARSTAD
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Credential | DC
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Telephone | 612-802-2580
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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 | 003258
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License Number State | MN
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