Healthcare Provider Details

I. General information

NPI: 1437609310
Provider Name (Legal Business Name): MINNESOTA NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 WILLOW LAKE BLVD #100
VADNAIS HEIGHTS MN
55110-5152
US

IV. Provider business mailing address

3485 WILLOW LAKE BLVD #100
VADNAIS HEIGHTS MN
55110-5152
US

V. Phone/Fax

Practice location:
  • Phone: 651-484-5567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1061
License Number StateMN

VIII. Authorized Official

Name: DR. CHRISTOPHER FOLEY
Title or Position: PHYSICIAN/OWNDER
Credential: M.D.
Phone: 651-484-5567