Healthcare Provider Details

I. General information

NPI: 1518251685
Provider Name (Legal Business Name): PETER WURDEMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6368 ELM STREET
NORTH BRANCH MN
55056-5459
US

IV. Provider business mailing address

6368 ELM STREET
NORTH BRANCH MN
55056-5459
US

V. Phone/Fax

Practice location:
  • Phone: 651-674-2700
  • Fax: 651-674-4135
Mailing address:
  • Phone: 651-674-2700
  • Fax: 651-674-4135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: