Provider Demographics
NPI:1972812725
Name:WESTERBERG CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:WESTERBERG CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WESTERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-689-0900
Mailing Address - Street 1:135 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1102
Mailing Address - Country:US
Mailing Address - Phone:763-689-0900
Mailing Address - Fax:
Practice Address - Street 1:135 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1102
Practice Address - Country:US
Practice Address - Phone:763-689-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002571Medicare PIN