Organization
ROOTS WELLCARE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLA JEAN BREUNIG D.C. (PRESIDENT/OWNER)
(651) 644-0455
Entity
Organization
Contact information
Practice address
570 ASBURY STREET, SUITE 102, ST PAUL, MN 55104-1852
(651) 310-0000
(651) 389-9491
Mailing address
570 ASBURY STREET, SUITE 102, ST PAUL, MN 55104-1852
(651) 310-0000
(651) 389-9491
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3123
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3123
CHIROPRACTIC LICENSE NO.
MN
05
—
465860400
—
MN
01
—
4C181BR
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/24/2008
Last updated
12/10/2008
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