Individual
TABITHA LYNN OLSEN-BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.A.C
Contact information
Practice address
1506 30TH AVE S, SUITE A, MOORHEAD, MN 56560-5195
(218) 422-5920
Mailing address
1506 30TH AVE S, SUITE A, MOORHEAD, MN 56560-5195
(218) 422-5920
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1825
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1825
MINNESOTA STATE LICENSE NUMBER
MN
Enumeration date
12/08/2016
Last updated
12/08/2016
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