=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821337577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC CARE OF OWATONNA PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2013
-----------------------------------------------------
Last Update Date | 07/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 N CEDAR
-----------------------------------------------------
City | OWATONNA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-214-2584
-----------------------------------------------------
Fax | 507-214-2584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 N CEDAR
-----------------------------------------------------
City | OWATONNA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-214-2584
-----------------------------------------------------
Fax | 507-214-2584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR OF CHIROPRACTIC CARE
-----------------------------------------------------
Name | LAURA LEE SEID
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 507-214-2584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4961
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------