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General NPI Number Information
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NPI Number | 1982744140
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Entity Type | Organization
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Legal Business Name | GOLDEN SUN CHIROPRACTIC WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 220 W 98TH ST STE 7
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2000
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Country | US
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Telephone | 952-922-1478
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Fax | 952-922-0248
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Provider Business Mailing Address
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Address Line | 220 W 98TH ST STE 7
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2000
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Country | US
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Telephone | 952-922-1478
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Fax | 952-922-0248
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | UNA YVETTE FORDE
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Credential | DC
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Telephone | 952-922-1478
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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 | 2875
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License Number State | MN
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