Healthcare Provider Details

I. General information

NPI: 1003373689
Provider Name (Legal Business Name): MINNEAPOLIS HEALTH & WELLNESS NE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 E HENNEPIN AVE SUITE 300
MINNEAPOLIS MN
55405
US

IV. Provider business mailing address

2704 GARFIELD ST NE
MINNEAPOLIS MN
55418-3018
US

V. Phone/Fax

Practice location:
  • Phone: 952-237-8549
  • Fax:
Mailing address:
  • Phone: 952-237-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL AILI MOORE
Title or Position: OWNER
Credential: DC
Phone: 952-237-8549