Healthcare Provider Details

I. General information

NPI: 1538758479
Provider Name (Legal Business Name): WELLWAY CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 NORTHWEST BLVD STE 230
PLYMOUTH MN
55441-2644
US

IV. Provider business mailing address

2905 NORTHWEST BLVD STE 230
PLYMOUTH MN
55441-2644
US

V. Phone/Fax

Practice location:
  • Phone: 612-367-4824
  • Fax:
Mailing address:
  • Phone: 612-367-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SARA PARKER
Title or Position: DIRECTOR OF CLIENT SERVICES
Credential:
Phone: 651-208-1275