Provider Demographics
NPI:1215123856
Name:BANDANA CHIROPRACTIC AND WELLNESS CENTER PA
Entity type:Organization
Organization Name:BANDANA CHIROPRACTIC AND WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:REINHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-646-2050
Mailing Address - Street 1:1912 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6113
Mailing Address - Country:US
Mailing Address - Phone:651-646-2050
Mailing Address - Fax:
Practice Address - Street 1:1912 LEXINGTON AVE N
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6113
Practice Address - Country:US
Practice Address - Phone:651-646-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002483Medicare PIN
MN350002482Medicare PIN