MEDICARE: RIESGRAF CHIROPRACTOR CLINIC 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1598933186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIESGRAF CHIROPRACTOR CLINIC LTD

Provider Business Mailing Address
First Line	:	1476 WHITE OAK DR
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2525
Country	:	US
Telephone Number	:	952-448-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1476 WHITE OAK DR
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2525
Country	:	US
Telephone Number	:	952-448-3900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALAN GERARD RIESGRAF
Credential	:	D.C.
Telephone Number	:	952-448-3900

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/14/2013

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