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General NPI Number Information
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NPI Number | 1972699403
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Entity Type | Organization
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Legal Business Name | CHIROZONE P.A.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9740 IRVING AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2625
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Country | US
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Telephone | 952-994-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 9740 IRVING AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2625
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Country | US
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Telephone | 952-994-0988
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Fax |
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | JEFFREY JAMES SMIDT
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Credential | D.C
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Telephone | 952-994-0988
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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 | 4152
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License Number State | MN
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