Individual
DR. STACY LANE HALLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C., C.C.E.P., CST
Contact information
Practice address
4350 S WASHINGTON ST, SUITE 100, GRAND FORKS, ND 58201-7184
(701) 732-2888
(701) 732-2711
Mailing address
1772 22ND ST NE, EMERADO, ND 58228-9788
(701) 594-8497
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
798
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407036627
—
MN
05
—
14609
—
ND
01
—
713023
PTAN
ND
Enumeration date
11/05/2007
Last updated
08/20/2008
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