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Organization

HICKORY HEALTH CLINIC PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RICHARD VINCENT OTTOMEYER DC (OWNER)
(651) 226-8338
Entity
Organization

Contact information

Practice address
168 LAKE ST S STE C, FOREST LAKE, MN 55025-4401
(651) 226-8338
Mailing address
23315 ITASCA AVE N, FOREST LAKE, MN 55025-8277
(651) 226-8338

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
51352700
MN
Enumeration date
02/03/2020
Last updated
02/17/2020
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