Provider Demographics
NPI:1619008067
Name:NESSETH CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:NESSETH CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:NESSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-286-6336
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-0818
Mailing Address - Country:US
Mailing Address - Phone:320-286-6336
Mailing Address - Fax:320-286-6337
Practice Address - Street 1:235 BROADWAY AVE S
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4681
Practice Address - Country:US
Practice Address - Phone:320-286-6336
Practice Address - Fax:320-286-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN051215003OtherPRIME WEST
MN19960NEOtherBCBS
MN218659400Medicaid
MN051215003OtherPRIME WEST
MN350003468Medicare ID - Type Unspecified