=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831488089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTER HEALTH CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2011
-----------------------------------------------------
Last Update Date | 03/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 SILVER BELL RD STE 9
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-452-7018
-----------------------------------------------------
Fax | 651-686-6130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 SILVER BELL RD STE 9
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-452-7018
-----------------------------------------------------
Fax | 651-686-6130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL JAY DECKERT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 651-452-7018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3798
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------