MEDICARE: THE FAMILY WELLNESS INSTITUTE, P. A.

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	5237	MN

General Provider Information

NPI Number	:	1356677801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY WELLNESS INSTITUTE, P. A.

Provider Business Mailing Address
First Line	:	4318 UPTON AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1555
Country	:	US
Telephone Number	:	612-767-4680
Fax Number	:	612-767-4686

Provider Business Practice Location Address
First Line	:	4318 UPTON AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1555
Country	:	US
Telephone Number	:	612-767-4680
Fax Number	:	612-767-4686

Authorized Official
Title or Position	:	C.E.O.
Name	:	DR. MATTHEW CURTIS HANSON
Credential	:	D.C.
Telephone Number	:	612-767-4680

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	10/19/2009

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