Provider Demographics
NPI:1639211253
Name:MITTAG HOLISTIC CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MITTAG HOLISTIC CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MITTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-934-0525
Mailing Address - Street 1:11812 WAYZATA BLVD.,
Mailing Address - Street 2:SUITE 224
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2012
Mailing Address - Country:US
Mailing Address - Phone:952-345-8245
Mailing Address - Fax:952-345-8246
Practice Address - Street 1:11812 WAYZATA BLVD.,
Practice Address - Street 2:SUITE 224
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2012
Practice Address - Country:US
Practice Address - Phone:952-345-8245
Practice Address - Fax:952-345-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty