Basic Information
| Provider Information | |||||||||
| NPI: | 1184817553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECKER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | L.AC., R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2644 BURD PL | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554262436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525463723 | ||||||||
| FaxNumber: | 6128636043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2833 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128633333 | ||||||||
| FaxNumber: | 6128636043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 08/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 1060 | MN | N | Other Service Providers | Acupuncturist | 183500000X | 112302 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.