Provider Demographics
NPI:1407160534
Name:MASON ORTH PC MN
Entity Type:Organization
Organization Name:MASON ORTH PC MN
Other - Org Name:HEALTHSOURCE OF LITTLE FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-632-9224
Mailing Address - Street 1:113 4TH ST NE STE 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-2719
Mailing Address - Country:US
Mailing Address - Phone:320-632-9224
Mailing Address - Fax:320-632-6303
Practice Address - Street 1:113 4TH ST NE STE 1
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-2719
Practice Address - Country:US
Practice Address - Phone:320-632-9224
Practice Address - Fax:320-632-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty