MEDICARE: DR. CHRISTOPHER P MASSOGLIA 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
1	111NS0005X	Sports Physician Chiropractor	2728	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720015191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER P MASSOGLIA D.C.

Provider Business Mailing Address
First Line	:	3640 TALMAGE CIR STE 216
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-7100
Country	:	US
Telephone Number	:	952-431-5330
Fax Number	:	952-432-5334

Provider Business Practice Location Address
First Line	:	3640 TALMAGE CIR STE 216
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110
Country	:	US
Telephone Number	:	952-431-5330
Fax Number	:	952-431-5334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/05/2018

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