Organization
SOUTHWEST BACK & NECK CLINC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D. MARLOW (PRESIDENT)
(612) 861-2752
Entity
Organization
Contact information
Practice address
6642 PENN AVE S, RICHFIELD, MN 55423-2026
(612) 861-2752
Mailing address
6642 PENN AVE S, RICHFIELD, MN 55423-2026
(612) 861-2752
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
002891
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033321096
INDIVIDUAL NPI
MN
Enumeration date
01/15/2008
Last updated
09/22/2009
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