Provider Demographics
NPI:1770638520
Name:PIETILA, JOHN ROBERT (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:PIETILA
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12358 RIVER RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1665
Mailing Address - Country:US
Mailing Address - Phone:952-681-7746
Mailing Address - Fax:952-681-7654
Practice Address - Street 1:12376 RIVER RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1665
Practice Address - Country:US
Practice Address - Phone:952-808-0987
Practice Address - Fax:952-808-0986
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4304111NN0400X, 111NN0400X
AZ7742111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology