Provider Demographics
NPI:1043555055
Name:HERMSEN, SAMANTHA MARIE DAVIDSON (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MARIE DAVIDSON
Last Name:HERMSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 BOUDIN ST NE STE 230
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1510
Mailing Address - Country:US
Mailing Address - Phone:952-447-0985
Mailing Address - Fax:952-447-0986
Practice Address - Street 1:6880 BOUDIN ST NE STE 230
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372
Practice Address - Country:US
Practice Address - Phone:952-447-0985
Practice Address - Fax:952-447-0986
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor