Provider Demographics
NPI:1063596773
Name:TEAM CHIROPRACTIC &WELLNESS CENTER
Entity type:Organization
Organization Name:TEAM CHIROPRACTIC &WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-295-0303
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-0962
Mailing Address - Country:US
Mailing Address - Phone:763-295-0303
Mailing Address - Fax:763-295-0303
Practice Address - Street 1:261 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-9317
Practice Address - Country:US
Practice Address - Phone:763-295-0303
Practice Address - Fax:763-295-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3823251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
27G60TEOtherBLUE CROSS BLUE SHIELD
U79245Medicare UPIN