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General NPI Number Information
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NPI Number | 1992993257
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Entity Type | Organization
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Legal Business Name | HEINZ FAMILY CHIROPRACTIC PA
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1698 N NOKOMIS ST NE
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5069
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Country | US
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Telephone | 320-763-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 1698 N NOKOMIS ST NE
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5069
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Country | US
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Telephone | 320-763-3333
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MELISSA ANN ROTH
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Credential | D.C.
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Telephone | 320-763-3333
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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 | 3355
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License Number State | MN
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