Provider Demographics
NPI:1881732451
Name:HARSTAD, ROBIN RACHEL (DC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RACHEL
Last Name:HARSTAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 200
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:763-755-4600
Practice Address - Street 1:1425 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 200
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350001694Medicare ID - Type UnspecifiedMEDICARE ID