Organization
CHIROPRACTIC WELLNESS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN OHARA (OWNER)
(763) 494-0090
Entity
Organization
Contact information
Practice address
11254 86TH AVE N, MAPLE GROVE, MN 55369-4510
(763) 494-0090
Mailing address
11254 86TH AVE N, MAPLE GROVE, MN 55369-4510
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3886
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
244T1NO
BCBS OF MN
MN
Enumeration date
12/28/2006
Last updated
01/31/2008
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