MEDICARE: MOUNDS VIEW CHIROPRACTIC, 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	4950	MN

General Provider Information

NPI Number	:	1306053673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNDS VIEW CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	5372 EDGEWOOD DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-1402
Country	:	US
Telephone Number	:	763-398-7770
Fax Number	:	763-398-7771

Provider Business Practice Location Address
First Line	:	5372 EDGEWOOD DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-1402
Country	:	US
Telephone Number	:	763-398-7770
Fax Number	:	763-398-7771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSHUA RYAN HUFFMAN
Credential	:	D.C.
Telephone Number	:	763-398-7770

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	01/23/2025

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