Healthcare Provider Details

I. General information

NPI: 1780681437
Provider Name (Legal Business Name): BEMIDJI HEALTH AND WELLNESS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 AMERICA AVE NW
BEMIDJI MN
56601-3122
US

IV. Provider business mailing address

403 AMERICA AVE NW
BEMIDJI MN
56601-3122
US

V. Phone/Fax

Practice location:
  • Phone: 218-444-8727
  • Fax: 218-444-8546
Mailing address:
  • Phone: 218-444-8727
  • Fax: 218-444-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateMN

VIII. Authorized Official

Name: SANYA MORTENSON-SWANSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 218-444-8727