Individual
DR. MICHAEL JOHN MODICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
7636 PINE TREE RD, SIDE LAKE, MN 55781-8441
(218) 969-4928
Mailing address
7636 PINE TREE RD, SIDE LAKE, MN 55781-8441
(218) 969-4928
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5322
MN
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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