Healthcare Provider Details

I. General information

NPI: 1629306584
Provider Name (Legal Business Name): GLOBAL WELLNESS MANAGEMENT COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TWELVE OAKS CENTER DR SUITE 101
WAYZATA MN
55391-4401
US

IV. Provider business mailing address

13150 1ST ST PO BOX 308
BECKER MN
55308-9320
US

V. Phone/Fax

Practice location:
  • Phone: 952-893-8900
  • Fax: 952-893-7399
Mailing address:
  • Phone: 952-893-8900
  • Fax: 952-893-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4009
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3880
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4190
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS HUSEBY
Title or Position: PRESIDENT
Credential:
Phone: 952-893-8900