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Organization
WILDWOOD WELLNESS LLC
Active
Organization
WILDWOOD WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSH HAGUE DC (OWNER)
(651) 249-5170
Entity
Organization
Contact information
Practice address
744 WILDWOOD RD, MAHTOMEDI, MN 55115-1852
(651) 300-4377
Mailing address
312 WARNER AVE S, WILLERNIE, MN 55090-7702
(651) 249-5170
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538758479
—
MN
Enumeration date
08/02/2022
Last updated
08/02/2022
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