Organization
INNOVATIVE CHIROPRACTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN SHANE LYSTAD D.C. (CO-OWNER)
(651) 448-1481
Entity
Organization
Contact information
Practice address
201 D EAST AVE., RED WING, MN 55041
(651) 448-1481
Mailing address
201 D EAST AVE., RED WING, MN 55041
(651) 448-1481
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
5976
MN
111N00000X
Chiropractor
Primary
5977
MN
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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