Provider Demographics
NPI:1700899168
Name:TOLLEFSON, RICHARD RAY (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAY
Last Name:TOLLEFSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 BUNKER LAKE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3787
Mailing Address - Country:US
Mailing Address - Phone:763-427-0820
Mailing Address - Fax:763-421-1040
Practice Address - Street 1:3368 BUNKER LAKE BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3787
Practice Address - Country:US
Practice Address - Phone:763-427-0820
Practice Address - Fax:763-421-1040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor