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General NPI Number Information
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NPI Number | 1275267775
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 906 3RD AVE
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City | WORTHINGTON
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State | MN
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Zip | 56187-2386
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Country | US
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Telephone | 507-343-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 906 3RD AVE
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City | WORTHINGTON
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State | MN
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Zip | 56187-2386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAIGE KINLEY
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Credential | D.C
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Telephone | 507-370-7777
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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 |
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License Number State |
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