Organization
EDWARD L REQUET DC PA
Active
Other names
Requet Chiropractic Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD LESLIE REQUET DC (OWNER)
(952) 975-2959
Entity
Organization
Contact information
Practice address
600 MARKET ST, SUITE 260 REQUET CHIROPRACTIC WELLNESS CENTER, CHANHASSEN, MN 55317
(952) 975-2959
(952) 975-2973
Mailing address
600 MARKET ST, SUITE 260, CHANHASSEN, MN 55317
(952) 975-2959
(952) 975-2973
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
MN3177
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4C665RE
BLUE CROSS
MN
01
—
4C666RE
BLUE CROSS
MN
Enumeration date
09/08/2006
Last updated
02/03/2011
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