Healthcare Provider Details

I. General information

NPI: 1023988920
Provider Name (Legal Business Name): CK WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VAN BUREN ST NE STE 200
MINNEAPOLIS MN
55413-3017
US

IV. Provider business mailing address

5744 11TH AVE S
MINNEAPOLIS MN
55417-2517
US

V. Phone/Fax

Practice location:
  • Phone: 612-800-8424
  • Fax:
Mailing address:
  • Phone: 608-963-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: CARLEY ROLLINS
Title or Position: OWNER
Credential: MS, CNS, LN
Phone: 608-963-3479