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General NPI Number Information
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NPI Number | 1831411727
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Entity Type | Organization
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Legal Business Name | GENESIS CHIROPRACTIC HEALTH CENTER
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 4678 SLATER RD
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City | EAGAN
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State | MN
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Zip | 55122-2362
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Country | US
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Telephone | 651-905-0330
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Fax | 651-905-0425
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Provider Business Mailing Address
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Address Line | 4678 SLATER RD
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City | EAGAN
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State | MN
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Zip | 55122-2362
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Country | US
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Telephone | 651-905-0330
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Fax | 651-905-0425
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. ERIK BRIAN HAN-LINDEMYER
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Credential | DC
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Telephone | 651-905-0330
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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 | 4179
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License Number State | MN
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