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Organization
CLUB WEST CHIROPRACTIC PA
Active
Organization
CLUB WEST CHIROPRACTIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYCEAN MARYRAE BERGH DC (VP)
(763) 400-4940
Entity
Organization
Contact information
Practice address
10950 CLUB WEST PKWY STE 190, BLAINE, MN 55449-5862
(763) 400-4940
Mailing address
10950 CLUB WEST PKWY STE 190, BLAINE, MN 55449-5862
(763) 400-4940
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
01/14/2015
Last updated
02/26/2024
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