=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760848576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK WESTPHAL D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2016
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 LAFAYETTE AVE SW
-----------------------------------------------------
City | EYOTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55934-6507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-585-0528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 LAFAYETTE AVE SW
-----------------------------------------------------
City | EYOTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55934-6507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-585-0528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6581
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------