Organization
FOSSTON CHIROPRACTIC CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GABRIEL WIENER DC (OWNER)
(218) 435-6186
Entity
Organization
Contact information
Practice address
104 JOHNSON AVE N, FOSSTON, MN 56542-1328
(218) 435-6186
Mailing address
104 JOHNSON AVE N, FOSSTON, MN 56542-1328
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4402
MN
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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