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General NPI Number Information
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NPI Number | 1972734135
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Entity Type | Organization
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Legal Business Name | POTTER CHIROPRACTIC
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 1620 17TH ST NW
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City | FARIBAULT
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State | MN
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Zip | 55021-2839
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Country | US
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Telephone | 507-334-7720
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Fax | 507-334-7725
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Provider Business Mailing Address
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Address Line | 1620 17TH ST NW
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City | FARIBAULT
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State | MN
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Zip | 55021-2839
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Country | US
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Telephone | 507-334-7720
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Fax | 507-334-7725
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Authorized Official
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Title or Position | D.C.
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Name | STEVEN POTTER
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Credential |
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Telephone | 507-334-7720
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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 | 4559
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License Number State | MN
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