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General NPI Number Information
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NPI Number | 1568695963
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Entity Type | Organization
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Legal Business Name | WHOLE FAMILY CHIROPRACTIC, PLC
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 2221 FORD PKWY STE 200
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City | SAINT PAUL
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State | MN
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Zip | 55116-3857
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Country | US
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Telephone | 651-789-0033
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Fax | 651-789-0969
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Provider Business Mailing Address
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Address Line | 2221 FORD PKWY STE 200
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City | SAINT PAUL
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State | MN
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Zip | 55116-3857
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Country | US
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Telephone | 651-789-0033
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Fax | 651-789-0969
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYE MOE
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Credential | D.C.
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Telephone | 651-789-0033
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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 | 5036
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License Number State | MN
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