Organization
AWAKEN LIFE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WILSON (DOCTOR/OWNER)
(612) 802-3646
Entity
Organization
Contact information
Practice address
8150 20TH ST SE, BUFFALO, MN 55313-4640
(844) 815-7625
Mailing address
2556 WESTVIEW TER, MINNETONKA, MN 55305-3118
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
04/02/2025
Last updated
04/02/2025
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