Organization
NORTHWEST SPINE AND PAIN CENTER OF ST. MICHAEL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD JEFFREY MATTILA D.C. (CEO)
(763) 497-0899
Entity
Organization
Contact information
Practice address
1 CENTRAL AVE W, SUITE 201, SAINT MICHAEL, MN 55376-4591
(763) 497-0899
(763) 497-4035
Mailing address
1 CENTRAL AVE W, SUITE 201, SAINT MICHAEL, MN 55376-4591
(763) 497-0899
(763) 497-4035
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4894
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306903299
INDIVIDUAL NPI
MN
Enumeration date
03/28/2007
Last updated
02/02/2009
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