Provider Demographics
NPI:1518014125
Name:KOTERBA, CHAD MARTIN (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MARTIN
Last Name:KOTERBA
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 SHADY OAK RD STE 325
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7834
Mailing Address - Country:US
Mailing Address - Phone:952-541-0148
Mailing Address - Fax:952-767-2422
Practice Address - Street 1:6640 SHADY OAK RD STE 325
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7834
Practice Address - Country:US
Practice Address - Phone:952-541-0148
Practice Address - Fax:952-767-2422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor