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Organization

GREAT LAKES CHIROPRACTIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PHILLIP J DETLEFSEN D.C. (OWNER)
(763) 420-4635
Entity
Organization

Contact information

Practice address
13601 80TH CIR N, SUITE 210, MAPLE GROVE, MN 55369-8999
(763) 420-4635
(763) 390-1381
Mailing address
13601 80TH CIR N, SUITE 210, MAPLE GROVE, MN 55369-8999
(763) 420-4635
(763) 390-1381

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4448
MN

Other

Enumeration date
03/21/2007
Last updated
06/24/2010
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