Healthcare Provider Details

I. General information

NPI: 1639092125
Provider Name (Legal Business Name): ROOTED TO BLOOM FUNCTIONAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 5TH AVE S STE 140
COLD SPRING MN
56320-2341
US

IV. Provider business mailing address

308 5TH AVE S STE 140
COLD SPRING MN
56320-2341
US

V. Phone/Fax

Practice location:
  • Phone: 320-200-9992
  • Fax:
Mailing address:
  • Phone: 320-200-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSEY HAUST
Title or Position: DNP
Credential:
Phone: 320-200-9992