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General NPI Number Information
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NPI Number | 1972968337
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Entity Type | Organization
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Legal Business Name | CORE CHIROPRACTIC & HEALTH
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2024
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Provider Practice Location Address
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Address Line | 219 WEDGEWOOD DR
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1800
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Country | US
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Telephone | 516-493-0701
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Fax | 651-674-3651
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Provider Business Mailing Address
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Address Line | 219 WEDGEWOOD DR
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1800
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Country | US
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Telephone | 516-493-0701
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Fax | 651-674-3651
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTOR/OWNER
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Name | VIRGINIA ROSE KAMPMEIER WETHERN
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Credential | DC
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Telephone | 651-493-0701
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4977
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License Number State | MN
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