| NPI | 1083120372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROCK J MADSEN Owner 320-269-7135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MN 2209) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6138) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2018-01-02 |