Provider Demographics
NPI:1992984959
Name:OSVOLD CHIROPRACTIC CORPORATED
Entity type:Organization
Organization Name:OSVOLD CHIROPRACTIC CORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:OSVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-854-3575
Mailing Address - Street 1:8230 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1716
Mailing Address - Country:US
Mailing Address - Phone:952-854-3575
Mailing Address - Fax:
Practice Address - Street 1:4811 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5510
Practice Address - Country:US
Practice Address - Phone:612-821-9770
Practice Address - Fax:612-216-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV04818Medicare UPIN
MNC03915Medicare PIN