MEDICARE: DUE NORTH WELLNESS CENTER PLLC

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	6060	MN

General Provider Information

NPI Number	:	1669840567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUE NORTH WELLNESS CENTER PLLC

Provider Business Mailing Address
First Line	:	1820 COON RAPIDS BLVD NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-4755
Country	:	US
Telephone Number	:	651-323-8954
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 COON RAPIDS BLVD NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-4755
Country	:	US
Telephone Number	:	651-323-8954
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL FOREST
Credential	:	DC, CLS
Telephone Number	:	651-323-8954

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	09/09/2015

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