Organization
ADVANCED WELLNESS & SPORTS REHAB PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE K SMITH DC (PRESIDENT)
(763) 458-6299
Entity
Organization
Contact information
Practice address
11132 COMMERCE LN N, CHAMPLIN, MN 55316-3112
(763) 291-0202
Mailing address
11132 COMMERCE LN N, CHAMPLIN, MN 55316-3112
(763) 291-0202
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
5614
MN
Other
Enumeration date
11/16/2014
Last updated
03/17/2018
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