MEDICARE: WARREN D HILDRETH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2592	MN

General Provider Information

NPI Number	:	1003131608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN D HILDRETH DC

Provider Business Mailing Address
First Line	:	6774 QUEENSLAND LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6774 QUEENSLAND LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3023
Country	:	US
Telephone Number	:	763-773-3109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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Directions to “ WARREN D HILDRETH DC” Practice Location

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