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General NPI Number Information
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NPI Number | 1912051756
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Entity Type | Organization
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Legal Business Name | EAST CENTRAL CHIROPRACTIC CLINIC, P.A.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 911 MAIN ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-2125
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Country | US
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Telephone | 763-689-1110
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Fax | 763-552-1110
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Provider Business Mailing Address
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Address Line | 911 MAIN ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-2125
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Country | US
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Telephone | 763-689-1110
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Fax | 763-552-1110
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DUANE NYBLOM
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Credential | D.C.
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Telephone | 763-689-1110
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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 |
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License Number State | MN
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