Basic Information
| Provider Information | |||||||||
| NPI: | 1356684039 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING GATE HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5851 DULUTH ST STE 115 | ||||||||
| Address2: | |||||||||
| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554223955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523931876 | ||||||||
| FaxNumber: | 9522231134 | ||||||||
| Practice Location | |||||||||
| Address1: | 5851 DULUTH ST STE 115 | ||||||||
| Address2: | |||||||||
| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554223955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523931876 | ||||||||
| FaxNumber: | 9522231134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | PFISTERER | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9524842176 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.CC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5264 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.