Organization
MICHAEL L. MARISTUEN D.C., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LAVERN MARISTUEN D.C. (OWNER)
(651) 639-1066
Entity
Organization
Contact information
Practice address
2216 COUNTY ROAD D W, SUITE B, SAINT PAUL, MN 55112-7500
(651) 639-1066
Mailing address
2216 COUNTY ROAD D W, SUITE B, SAINT PAUL, MN 55112-7500
(651) 639-1066
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4409
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
318G5SP
BLUE CROSS BLUE SHIELD
MN
01
—
C03495
NPPES
MN
Enumeration date
06/26/2007
Last updated
08/22/2020
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