Healthcare Provider Details

I. General information

NPI: 1962689901
Provider Name (Legal Business Name): JUSTIN D.W. NYE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 SEASONS PKWY STE 200
WOODBURY MN
55125-3476
US

IV. Provider business mailing address

8401 SEASONS PKWY STE 200
WOODBURY MN
55125-3476
US

V. Phone/Fax

Practice location:
  • Phone: 651-731-0505
  • Fax: 651-731-0500
Mailing address:
  • Phone: 651-731-0505
  • Fax: 651-731-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5068
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: