| NPI | 1285930313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE FOKKEN Vice President 763-551-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 44760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4547) |
| 111N00000X Chiropractor (Licence: MN 4505) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 8833) | |
| 363AM0700X Physician Assistant, Medical (Licence: MN 9656) | |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2013-01-17 |