Healthcare Provider Details

I. General information

NPI: 1710078407
Provider Name (Legal Business Name): WOODLANDS CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 29TH AVE N
SAINT CLOUD MN
56303-4589
US

IV. Provider business mailing address

48 29TH AVE N
SAINT CLOUD MN
56303-4589
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-0300
  • Fax: 320-240-0303
Mailing address:
  • Phone: 320-240-0300
  • Fax: 320-240-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number537
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6076
License Number StateMN

VIII. Authorized Official

Name: MR. MICHAEL S BALFANZ
Title or Position: OWNER/DC
Credential: DC
Phone: 320-240-0300