Provider Demographics
NPI:1740555143
Name:OVERSTAD CHIROPRACTIC,P.A.
Entity type:Organization
Organization Name:OVERSTAD CHIROPRACTIC,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:HARSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-802-2580
Mailing Address - Street 1:1425 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5386
Mailing Address - Country:US
Mailing Address - Phone:612-802-2580
Mailing Address - Fax:
Practice Address - Street 1:1425 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5386
Practice Address - Country:US
Practice Address - Phone:612-802-2580
Practice Address - Fax:763-755-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350001694Medicare PIN