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NPI Code Detail

MEDICARE: DR. WILLIAM C HARRALSON D.C.

MEDICARE: DR. WILLIAM C HARRALSON 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
1111NX0100XOccupational Health Chiropractor3746MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13746OTHERMNLICENSE

General Provider Information

NPI Number : 1245272186
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM C HARRALSON D.C.
Provider Business Mailing Address
First Line : 3015 UTAH AVE S
Second Line : SUITE 200
City : SAINT LOUIS PARK
State : MN
Zip : 55426-3671
Country : US
Telephone Number : 952-933-1121
Fax Number : 952-945-9635
Provider Business Practice Location Address
First Line : 3015 UTAH AVE S
Second Line : SUITE 200
City : SAINT LOUIS PARK
State : MN
Zip : 55426-3671
Country : US
Telephone Number : 952-933-1121
Fax Number : 952-945-9635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 07/09/2007

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