Individual
DR. ALISA T MITSKOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
319 11TH ST N, WAHPETON, ND 58075-4111
(701) 642-6480
(701) 642-6011
Mailing address
1001 2ND AVE N, WAHPETON, ND 58075-4309
(701) 642-6444
(701) 642-6011
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
500
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17175
—
ND
05
—
922509900
—
MN
Enumeration date
07/11/2006
Last updated
07/06/2016
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