MEDICARE: CASEY J OIE PA

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	2286	MN

General Provider Information

NPI Number	:	1083882500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASEY J OIE PA

Provider Business Mailing Address
First Line	:	16550 W 78TH ST
Second Line	:	SUITE C
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-4315
Country	:	US
Telephone Number	:	952-974-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	16550 W 78TH ST
Second Line	:	SUITE C
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-4315
Country	:	US
Telephone Number	:	952-974-9740
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CASEY OIE
Credential	:	DC
Telephone Number	:	952-974-9740

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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