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General NPI Number Information
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NPI Number | 1851463475
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Entity Type | Organization
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Legal Business Name | NOKOMIS CHIROPRACTIC CENTER P.A.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5313 LYNDALE AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-1229
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Country | US
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Telephone | 612-822-0149
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Fax | 612-822-7441
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Provider Business Mailing Address
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Address Line | 5313 LYNDALE AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-1229
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Country | US
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Telephone | 612-822-0149
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Fax | 612-822-7441
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Authorized Official
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Title or Position | CEO
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Name | DR. JONATHAN W OLSON
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Credential | D.C.
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Telephone | 612-822-0149
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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 | 2735
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License Number State | MN
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