Provider Demographics
NPI:1245272186
Name:HARRALSON, WILLIAM C (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:HARRALSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3015 UTAH AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3671
Mailing Address - Country:US
Mailing Address - Phone:952-933-1121
Mailing Address - Fax:952-945-9635
Practice Address - Street 1:3015 UTAH AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3671
Practice Address - Country:US
Practice Address - Phone:952-933-1121
Practice Address - Fax:952-945-9635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3746111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3746OtherLICENSE