Mitskog, Alisa T

Mitskog, Alisa T is an individual health care provider with primary practice located at 319 11Th St N , Wahpeton ND 58075-4111. She recently has only one registered license in Chiropractic Providers / Sports Physician, which is considered as her primary health care specialty. Mitskog, Alisa T can be contacted via phone (701) 642-6480.

Contact Information

Primary practice address
319 11Th St N Wahpeton ND 58075-4111
Phone: (701) 642-6480
Fax: (701) 642-6011
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Sports Physician 111NS0005X 500 North Dakota

Profile Details

NPI number 1578598587
LBN Legal business name Mitskog, Alisa T
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Jul 6th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578598587 NPPES
Minnesota MEDICAID 922509900
Minnesota MEDICAID 17175

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