Healthcare Provider Details

I. General information

NPI: 1548637739
Provider Name (Legal Business Name): TRIAGE WELLNESS INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST SUITE 101
ELKO NEW MARKET MN
55054-5461
US

IV. Provider business mailing address

321 MAIN ST SUITE 101
ELKO NEW MARKET MN
55054-5461
US

V. Phone/Fax

Practice location:
  • Phone: 952-226-4325
  • Fax:
Mailing address:
  • Phone: 952-226-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number101110
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4326
License Number StateMN

VIII. Authorized Official

Name: DR. JAMES DANIEL BUESGENS
Title or Position: OWNER
Credential: OTR, DC
Phone: 952-226-4325