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Organization
PAIN RELIEF AND WELLNESS OF MINNESOTA
Active
Organization
PAIN RELIEF AND WELLNESS OF MINNESOTA
Active
Other names
Locketz Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADAM JASON LOCKETZ MD (OWNER/MD)
(651) 249-0454
Entity
Organization
Contact information
Practice address
4721 CLARK AVE, WHITE BEAR LAKE, MN 55110-3221
(651) 249-0454
(651) 560-7013
Mailing address
4721 CLARK AVE, WHITE BEAR LAKE, MN 55110-3221
(651) 788-6689
(651) 560-7013
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34536300
—
WI
05
—
530615900
—
MN
Enumeration date
04/11/2011
Last updated
02/13/2014
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