Organization
SOUTHWEST CHIROPRACTIC. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY DALE WILDBERG (OWNER)
(715) 748-2334
Entity
Organization
Contact information
Practice address
7565 OFFICE RIDGE CIR, EDEN PRAIRIE, MN 55344-3651
(952) 943-1188
(952) 943-1177
Mailing address
7565 OFFICE RIDGE CIR, EDEN PRAIRIE, MN 55344-3651
(952) 943-1188
(952) 943-1177
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2103
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4477843
HEALTH SERVICES MGMT, INC
MN
01
—
59878NO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
05/23/2007
Last updated
04/17/2024
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