MEDICARE: DR. MALLORY ERIN RANEM 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	111N00000X	Chiropractor	5248	MN

General Provider Information

NPI Number	:	1770712028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALLORY ERIN RANEM D.C.

Provider Business Mailing Address
First Line	:	1926 MINNEHAHA AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119
Country	:	US
Telephone Number	:	651-303-8768
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 MINNEHAHA AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-3913
Country	:	US
Telephone Number	:	651-303-8768
Fax Number	:

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	07/08/2009

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