Individual
SANYA SHEREE MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
403 AMERICA AVE NW, BEMIDJI, MN 56601-3122
(218) 444-8727
(218) 444-8546
Mailing address
4680 SHERMAN DR NE, BEMIDJI, MN 56601-5359
(218) 444-8727
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3546
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292526500
—
MN
01
—
397L2MO
BLUE CROSS/BLUE SHIELD
MN
01
—
770299
AMERICA'S PPO
MN
Enumeration date
07/07/2005
Last updated
06/18/2015
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