Provider Demographics
NPI:1528318474
Name:SPOLARICH, TRISTA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:TRISTA
Middle Name:ELIZABETH
Last Name:SPOLARICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 DEAN PKWY
Mailing Address - Street 2:APT 311
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4455
Mailing Address - Country:US
Mailing Address - Phone:218-851-2499
Mailing Address - Fax:
Practice Address - Street 1:3900 VINEWOOD LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1155
Practice Address - Country:US
Practice Address - Phone:763-559-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor