MEDICARE: HEALING TREE CHIROPRACTIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4912	MN

General Provider Information

NPI Number	:	1073799110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING TREE CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	6311 WAYZATA BLVD
Second Line	:	SUITE 330
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1209
Country	:	US
Telephone Number	:	952-345-8244
Fax Number	:	952-933-6410

Provider Business Practice Location Address
First Line	:	6311 WAYZATA BLVD
Second Line	:	SUITE 330
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1209
Country	:	US
Telephone Number	:	952-345-8244
Fax Number	:	952-933-6410

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIE FLORA
Credential	:	D.C.
Telephone Number	:	763-443-6861

Provider Enumeration Date	:	01/19/2008
Last Update Date	:	01/19/2008

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