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General NPI Number Information
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NPI Number | 1851839955
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Entity Type | Organization
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Legal Business Name | TRILLIUM SPINAL CARE PLC
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 2300 SUPERIOR DR NW SUITE 2
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City | ROCHESTER
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State | MN
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Zip | 55901-3061
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Country | US
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Telephone | 507-322-0133
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 SUPERIOR DR NW SUITE 2
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City | ROCHESTER
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State | MN
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Zip | 55901-3061
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Country | US
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Telephone | 507-322-0133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KALAN CLETE STITTLEBURG
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Credential | D.C.
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Telephone | 715-937-0549
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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 | 6317
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6314
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License Number State | MN
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