Organization
TWWMAD LLC
Active
Other names
Lifestyle Wellness Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY HICE (OWNER)
(218) 330-6333
Entity
Organization
Contact information
Practice address
7111 FORTHUN RD STE 200, BAXTER, MN 56425-8596
(218) 820-1516
Mailing address
7111 FORTHUN RD STE 200, BAXTER, MN 56425-8596
(218) 820-1516
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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