Healthcare Provider Details

I. General information

NPI: 1316086598
Provider Name (Legal Business Name): FAMILY HEALTH TRUST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12321 MINNETONKA BLVD
MINNETONKA MN
55305-3964
US

IV. Provider business mailing address

12321 MINNETONKA BLVD
MINNETONKA MN
55305-3964
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-4427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1673
License Number StateMN

VIII. Authorized Official

Name: DR. KELLY JOHN SHEEHAN
Title or Position: CEO
Credential: DC
Phone: 952-933-4427