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Organization

MYSTICAL ROSE CHIROPRACTIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CATHERINE WANJIRU NJOGU D.C. (PRESIDENT)
(612) 310-8662
Entity
Organization

Contact information

Practice address
8200 HUMBOLDT AVE S, SUITE 204, BLOOMINGTON, MN 55431-1433
(952) 884-6144
(952) 884-9180
Mailing address
8200 HUMBOLDT AVE S, SUITE 204, BLOOMINGTON, MN 55431-1433
(952) 884-6144
(952) 884-9180

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
1094
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C05946
MEDICARE PTAN NUMBER
MN
Enumeration date
10/20/2011
Last updated
04/15/2013
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