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General NPI Number Information
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NPI Number | 1831250810
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Entity Type | Organization
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Legal Business Name | AUDETTE CHIROPRACTIC CLINIC P.A.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 438 N 57TH AVE W
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City | DULUTH
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State | MN
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Zip | 55807-3723
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Country | US
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Telephone | 218-624-5759
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Fax | 218-624-4668
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Provider Business Mailing Address
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Address Line | 438 N 57TH AVE W
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City | DULUTH
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State | MN
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Zip | 55807-3723
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Country | US
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Telephone | 218-624-5759
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Fax | 218-624-4668
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTINE ANN AUDETTE
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Credential | D.C.
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Telephone | 218-624-5759
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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 | 2105
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License Number State | MN
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