=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871780049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC CARE OF OWATONNA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2007
-----------------------------------------------------
Last Update Date | 10/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 HILLCREST AVE STE 120
-----------------------------------------------------
City | OWATONNA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55060-3680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-214-2584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 HILLCREST AVE STE 120
-----------------------------------------------------
City | OWATONNA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55060-3680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-214-2584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. LAURA LEE SEID
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 507-214-2584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 4961
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------