Individual
DR. RICHARD VINCENT OTTOMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
168 LAKE ST S STE C, FOREST LAKE, MN 55025-4401
(651) 226-8338
Mailing address
23315 ITASCA AVE N, FOREST LAKE, MN 55025-8277
(651) 226-8338
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1818
MN
111NX0800X
Orthopedic Chiropractor
Primary
1818
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
513527000
—
MN
Enumeration date
10/03/2005
Last updated
02/06/2020
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