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General NPI Number Information
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NPI Number | 1194042135
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Entity Type | Organization
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Legal Business Name | EMERGENT HEALTH CHIROPRACTIC WELLNESS, INC
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 1895 PLAZA DR SUITE 200
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City | EAGAN
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State | MN
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Zip | 55122-4600
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Country | US
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Telephone | 651-688-8886
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Fax | 651-688-2702
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Provider Business Mailing Address
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Address Line | 1895 PLAZA DR SUITE 200
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City | EAGAN
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State | MN
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Zip | 55122-4600
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Country | US
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Telephone | 651-688-8886
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Fax | 651-688-2702
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CANDACE RAE HARVEY
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Credential |
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Telephone | 651-688-8886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3010
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License Number State | MN
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