Provider Demographics
NPI:1922250372
Name:CHAMPION, NATHAN MICHAEL (ND)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MICHAEL
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10505 WAYZATA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1502
Mailing Address - Country:US
Mailing Address - Phone:952-417-1912
Mailing Address - Fax:952-417-1913
Practice Address - Street 1:10505 WAYZATA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:952-417-1912
Practice Address - Fax:952-417-1913
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ07-1009175F00000X
MN1018175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1962677815OtherNPI FOR ORGANIZATION
AZ1962677815OtherNPI # FOR MY PRACTICE (ORGANIZATION)