Healthcare Provider Details

I. General information

NPI: 1275490922
Provider Name (Legal Business Name): DR. ANJALI GRACE WHITE REISDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27900 QUARRY RD
LINDSTROM MN
55045-8093
US

IV. Provider business mailing address

27900 QUARRY RD
LINDSTROM MN
55045-8093
US

V. Phone/Fax

Practice location:
  • Phone: 651-400-0383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7400
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: