MEDICARE: WURDEMANN 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518251685	OTHER	MN	NPI FOR INDIVIDUAL - DR. PETER WURDEMANN

General Provider Information

NPI Number	:	1578850061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WURDEMANN CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	6368 ELM STREET
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-0094
Country	:	US
Telephone Number	:	651-674-2700
Fax Number	:	651-674-4135

Provider Business Practice Location Address
First Line	:	6272 MAIN ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6593
Country	:	US
Telephone Number	:	651-674-2700
Fax Number	:	651-674-4135

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER WURDEMANN
Credential	:	D.C.
Telephone Number	:	651-674-2700

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	06/13/2023

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