MEDICARE: WAYZATA CHIROPRACTIC CLINIC

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	3146	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C01037	OTHER	MN	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1588831697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYZATA CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	101 LAKE ST W STE 100
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-1577
Country	:	US
Telephone Number	:	952-473-4241
Fax Number	:	952-473-5415

Provider Business Practice Location Address
First Line	:	101 LAKE ST W STE 100
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-1577
Country	:	US
Telephone Number	:	952-473-4241
Fax Number	:	952-473-5415

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KARA LYNN ARNE
Credential	:	D.C.
Telephone Number	:	952-473-4241

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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Directions to “WAYZATA CHIROPRACTIC CLINIC ” Practice Location

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