Healthcare Provider Details

I. General information

NPI: 1083897243
Provider Name (Legal Business Name): URWC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 COUNTY ROAD E E
VADNAIS HEIGHTS MN
55110-4637
US

IV. Provider business mailing address

1654 COUNTY ROAD E E
VADNAIS HEIGHTS MN
55110-4637
US

V. Phone/Fax

Practice location:
  • Phone: 651-739-1248
  • Fax: 651-264-9844
Mailing address:
  • Phone: 651-739-1248
  • Fax: 651-264-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2372
License Number StateMN

VIII. Authorized Official

Name: DR. KEVIN SEAN CONNERS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 651-739-1248