Healthcare Provider Details

I. General information

NPI: 1093624587
Provider Name (Legal Business Name): MECCA HEALTH EPICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 COMMERCE DR
NORTH MANKATO MN
56003-1802
US

IV. Provider business mailing address

1761 COMMERCE DR
NORTH MANKATO MN
56003-1802
US

V. Phone/Fax

Practice location:
  • Phone: 507-995-0226
  • Fax:
Mailing address:
  • Phone: 507-995-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MAXAMILLION ANTHONY METTLER
Title or Position: CO-FOUNDER
Credential: DC, DPHCS
Phone: 507-995-0226