Healthcare Provider Details

I. General information

NPI: 1760018337
Provider Name (Legal Business Name): BONITA BOLSA DBA TWIN CITIES NATURAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 3RD ST NE STE B
OSSEO MN
55369-1212
US

IV. Provider business mailing address

24 3RD ST NE STE B
OSSEO MN
55369-1212
US

V. Phone/Fax

Practice location:
  • Phone: 612-524-8764
  • Fax:
Mailing address:
  • Phone: 612-524-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KERSTIN SCHULZ
Title or Position: OWNER
Credential:
Phone: 612-524-8764