MEDICARE: DAHL CHIROPRACTIC SERVICES

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	2647	MN

General Provider Information

NPI Number	:	1871794578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAHL CHIROPRACTIC SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 19252
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-0252
Country	:	US
Telephone Number	:	612-823-1702
Fax Number	:	612-224-9817

Provider Business Practice Location Address
First Line	:	ONE GROVELAND TERRACE
Second Line	:	SUITE #202
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-1174
Country	:	US
Telephone Number	:	612-823-1702
Fax Number	:	612-354-7577

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY JAMES DAHL
Credential	:	D.C.
Telephone Number	:	612-823-1702

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	06/04/2015

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