Provider Demographics
NPI:1679615389
Name:MITTAG, HARLAN FRANCIS (DC)
Entity type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:FRANCIS
Last Name:MITTAG
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 1:11812 WAYZATA BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2012
Mailing Address - Country:US
Mailing Address - Phone:952-345-8245
Mailing Address - Fax:952-345-8246
Practice Address - Street 1:11812 WAYZATA BLVD STE 224
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2012
Practice Address - Country:US
Practice Address - Phone:952-345-8245
Practice Address - Fax:952-345-8246
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002328111N00000X
MN2328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN981228800Medicaid