| NPI | 1306919998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY THOMAS GULLICKSON Owner 952-927-6639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2596) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2937) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2014-11-25 |