1356892285 NPI number — DMR CLINIC ROGERS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356892285 NPI number — DMR CLINIC ROGERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DMR CLINIC ROGERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356892285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 QUANTRELLE AVE NE STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTSEGO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55330-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-432-9866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 QUANTRELLE AVE NE STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTSEGO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55330-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-432-9866
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HEIDE
Authorized Official First Name:
MICHLYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
612-670-9026

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5257 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350004449 . This is a "MEDICARE ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com