Provider Demographics
NPI:1104126234
Name:CHIROPRACTIC WELLNESS CENTER OF DINKYTOWN LLC
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER OF DINKYTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-940-7171
Mailing Address - Street 1:1313 5TH ST SE
Mailing Address - Street 2:SUITE 130, MAILBOX 89
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:SUITE 130, MAILBOX 89
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:612-940-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 3073261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service