Provider Demographics
NPI:1356683114
Name:OLTMANNS, ERIC MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:OLTMANNS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4886
Mailing Address - Country:US
Mailing Address - Phone:320-252-3711
Mailing Address - Fax:320-240-0608
Practice Address - Street 1:251 COUNTY ROAD 120 STE B
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4886
Practice Address - Country:US
Practice Address - Phone:320-252-3711
Practice Address - Fax:320-240-0608
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT70889Medicare UPIN