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General NPI Number Information
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NPI Number | 1831278449
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Entity Type | Organization
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Legal Business Name | WILLOW CREEK CHIROPRACTIC, PA
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 5922 LEXINGTON AVE N
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City | SHOREVIEW
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State | MN
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Zip | 55126-5604
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Country | US
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Telephone | 651-784-3396
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Fax | 651-784-7247
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Provider Business Mailing Address
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Address Line | 5922 LEXINGTON AVE N
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City | SHOREVIEW
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State | MN
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Zip | 55126-5604
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Country | US
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Telephone | 651-784-3396
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Fax | 651-784-7247
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL DOUGLAS HEAD
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Credential | DC
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Telephone | 651-784-3396
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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 | 3281
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License Number State | MN
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