Healthcare Provider Details

I. General information

NPI: 1578850061
Provider Name (Legal Business Name): WURDEMANN CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6272 MAIN ST
NORTH BRANCH MN
55056-6593
US

IV. Provider business mailing address

6368 ELM STREET
NORTH BRANCH MN
55056-0094
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 Number
License Number State

VIII. Authorized Official

Name: DR. PETER WURDEMANN
Title or Position: OWNER
Credential: D.C.
Phone: 651-674-2700