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General NPI Number Information
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NPI Number | 1992984959
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Entity Type | Organization
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Legal Business Name | OSVOLD CHIROPRACTIC CORPORATED
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 4811 NICOLLET AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-5510
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Country | US
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Telephone | 612-821-9770
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Fax | 612-216-4296
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Provider Business Mailing Address
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Address Line | 8230 14TH AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1716
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Country | US
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Telephone | 952-854-3575
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHELDON MATTHEW OSVOLD
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Credential | D.C.
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Telephone | 952-854-3575
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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 | 4078
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License Number State | MN
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