MEDICARE: MANKATO CHIROPRACTIC RIVER'S EDGE

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	3058	MN

General Provider Information

NPI Number	:	1801033931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANKATO CHIROPRACTIC RIVER'S EDGE

Provider Business Mailing Address
First Line	:	1900 N SUNRISE DR
Second Line	:	STE 100
City	:	SAINT PETER
State	:	MN
Zip	:	56082-5376
Country	:	US
Telephone Number	:	507-345-4035
Fax Number	:	507-345-4122

Provider Business Practice Location Address
First Line	:	1900 N SUNRISE DR
Second Line	:	STE 100
City	:	SAINT PETER
State	:	MN
Zip	:	56082-5376
Country	:	US
Telephone Number	:	507-345-4035
Fax Number	:	507-345-4122

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA L MARSHALL
Credential	:	DC
Telephone Number	:	507-345-4035

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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Directions to “MANKATO CHIROPRACTIC RIVER'S EDGE ” Practice Location

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