Provider Demographics
NPI:1083923460
Name:PIETILA CHIROPRACTIC
Entity Type:Organization
Organization Name:PIETILA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIETILA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-709-2737
Mailing Address - Street 1:12358 RIVER RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1665
Mailing Address - Country:US
Mailing Address - Phone:952-681-7746
Mailing Address - Fax:952-681-7654
Practice Address - Street 1:12358 RIVER RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1665
Practice Address - Country:US
Practice Address - Phone:952-681-7746
Practice Address - Fax:952-681-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4304111NN0400X
MN4857111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty