Provider Demographics
NPI:1578541843
Name:MINSER, MARY BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:MINSER
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 1:203 PARK AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3779
Mailing Address - Country:US
Mailing Address - Phone:320-253-5650
Mailing Address - Fax:320-253-9222
Practice Address - Street 1:203 PARK AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3779
Practice Address - Country:US
Practice Address - Phone:320-253-5650
Practice Address - Fax:320-253-9222
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106171100000X
MN2734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN213728300Medicaid
MN231498OtherCHIROCARE
MN350040610OtherRAIL ROAD MEDICARE
MN0006QOtherHSM ELECT
MN64544MIOtherBCBS
MN0048OtherHSM