MEDICARE: DR. SAMANTHA MARIE DAVIDSON HERMSEN D.C.

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	5713	MN

General Provider Information

NPI Number	:	1043555055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA MARIE DAVIDSON HERMSEN D.C.

Provider Business Mailing Address
First Line	:	6880 BOUDIN ST NE STE 230
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-1510
Country	:	US
Telephone Number	:	952-447-0985
Fax Number	:	952-447-0986

Provider Business Practice Location Address
First Line	:	6880 BOUDIN ST NE STE 230
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372
Country	:	US
Telephone Number	:	952-447-0985
Fax Number	:	952-447-0986

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

Provider Enumeration Date	:	12/02/2012
Last Update Date	:	09/03/2019

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