Provider Demographics
NPI:1265904262
Name:TOLVSTAD, ASHLEY (DC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TOLVSTAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MERTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8511 HAEG DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1725
Mailing Address - Country:US
Mailing Address - Phone:218-230-0294
Mailing Address - Fax:
Practice Address - Street 1:20 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1020
Practice Address - Country:US
Practice Address - Phone:952-442-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor