| NPI | 1427447432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYCEAN MARYRAE BERGH VP 763-400-4940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2024-02-26 |