Healthcare Provider Details

I. General information

NPI: 1770802019
Provider Name (Legal Business Name): CHIROPRACTIC AND WELLNESS CENTER OF ALBERTVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 LACENTRE AVENUE NE SUITE 202
ALBERTVILLE MN
55301
US

IV. Provider business mailing address

5676 LACENTRE AVE SUITE 204
ALBERTVILLE MN
55301
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-0777
  • Fax: 763-497-5377
Mailing address:
  • Phone: 763-497-0777
  • Fax: 763-497-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5292
License Number StateMN

VIII. Authorized Official

Name: ANDREW KONZ
Title or Position: OWNER
Credential: D.C.
Phone: 763-497-0777