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General NPI Number Information
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NPI Number | 1881806552
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Entity Type | Organization
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Legal Business Name | CHARGER CHIROPRACTIC & SOFT TISSUE CENTER P.C.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 450 4TH STREET NORTH
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City | DASSEL
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State | MN
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Zip | 55321
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Country | US
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Telephone | 320-275-2000
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Fax | 320-275-2800
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Provider Business Mailing Address
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Address Line | 450 4TH STREET NORTH P O BOX 2
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City | DASSEL
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State | MN
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Zip | 55321
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Country | US
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Telephone | 320-275-2000
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Fax | 320-275-2800
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANE MATHEW COLBERG
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Credential | DC
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Telephone | 320-275-2000
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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 | 4884
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License Number State | MN
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