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Organization
NORTHWEST SPINE AND PAIN CENTER OF ST. MICHAEL, PA
Active
Organization
NORTHWEST SPINE AND PAIN CENTER OF ST. MICHAEL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD JEFFREY MATTILA D.C. (CEO)
(763) 497-0899
Entity
Organization
Contact information
Practice address
1 CENTRAL AVE W, SUITE 201, SAINT MICHAEL, MN 55376-4591
(763) 497-0899
(763) 497-4035
Mailing address
1 CENTRAL AVE W, SUITE 201, SAINT MICHAEL, MN 55376-4591
(763) 497-0899
(763) 497-4035
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4894
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306903299
INDIVIDUAL NPI
MN
Enumeration date
03/28/2007
Last updated
02/02/2009
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