# 612 CHIROPRACTIC & WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518414382
- **Authorized official:** KELLEY LUMBARD DC (OWNER)
- **Authorized official phone:** (612) 578-6001

## Contact information

- **Practice address:** 750 MAIN ST, SUITE 100, MENDOTA HEIGHTS, MN 55118-3764
- **Practice address phone:** (612) 578-6001
- **Mailing address:** 2211 MONROE ST NE, MINNEAPOLIS, MN 55418-3635
- **Mailing address phone:** (612) 578-6001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 6232 | MN | Yes |

## Other

- **Enumeration date:** 09/08/2016
- **Last updated:** 09/08/2016