MEDICARE: DEHEN CHIROPRACTIC, LTD.

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	261Q00000X	Clinic/Center	2374	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	230189	OTHER	MN	OTHER
2	2D596DE	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1356458582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEHEN CHIROPRACTIC, LTD.

Provider Business Mailing Address
First Line	:	1706 LOR RAY DR
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-1939
Country	:	US
Telephone Number	:	507-388-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 LOR RAY DR
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-1939
Country	:	US
Telephone Number	:	507-388-7744
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK DAVID DEHEN
Credential	:	D.C.
Telephone Number	:	507-388-7744

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/22/2020

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Directions to “DEHEN CHIROPRACTIC, LTD. ” Practice Location

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