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General NPI Number Information
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NPI Number | 1780703678
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC HEALTH & WELLNESS CENTER, P.A.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 3400 W. 66TH ST. SUITE 128
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City | EDINA
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State | MN
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Zip | 55435-2109
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Country | US
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Telephone | 952-835-6750
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Fax | 952-835-4723
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Provider Business Mailing Address
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Address Line | 3400 W. 66TH ST. SUITE 128
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City | EDINA
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State | MN
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Zip | 55435-2109
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Country | US
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Telephone | 952-835-6750
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Fax | 952-835-4723
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NANCY D. FARGO
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Credential |
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Telephone | 952-835-6750
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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 | MN
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