Organization
SELECT LIFE CHIROPRACTIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN J HOKANSON D.C. (PRESIDENT)
(218) 829-8200
Entity
Organization
Contact information
Practice address
429 8TH AVE NE, BRAINERD, MN 56401-2806
(218) 829-8200
(218) 829-8201
Mailing address
429 8TH AVE NE, BRAINERD, MN 56401-2806
(218) 829-8200
(218) 829-8201
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4008
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07N43HE
BLUE CROSS BLUE SHIELD
MN
05
—
115504100
—
MN
Enumeration date
09/25/2006
Last updated
09/29/2008
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