Provider Demographics
NPI:1194945253
Name:WOELFEL, DONNA J (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:WOELFEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:BERGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2499 RICE ST
Mailing Address - Street 2:204
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3724
Mailing Address - Country:US
Mailing Address - Phone:651-481-3292
Mailing Address - Fax:651-481-7821
Practice Address - Street 1:2499 RICE ST
Practice Address - Street 2:204
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3724
Practice Address - Country:US
Practice Address - Phone:651-481-3292
Practice Address - Fax:651-481-7821
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C826W0OtherBLUE CROSS INDIVIDUAL
MN4C825ADOtherBLUE CROSS CLINIC NUMBER
MN003090OtherCHIROPRACTIC LICENSE NUMB