Big Lake Spine & Sport, PA

NPI #1295747889 in Monticello, Minnesota

Provider Information

NPI Number: 1295747889
Entity Type: Organization
Organization Name: Big Lake Spine & Sport, PA
Primary Specialty: Chiropractor
Enumeration Date: Aug 12, 2006
Last Updated: Oct 18, 2019

Practice Location

Address: 1260 HIGHWAY 25 S
City: Monticello
State: Minnesota
ZIP Code: 55362-8921
Phone: (763) 260-8401

Authorized Official

Name: BILL E MICKLE, DC
Title: OWNER
Phone: (763) 260-8401

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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