Provider Demographics
NPI:1275370215
Name:EXPERIENCE WELLNESS CHIROPRACTIC PA
Entity type:Organization
Organization Name:EXPERIENCE WELLNESS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:FAUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-670-1742
Mailing Address - Street 1:3001 HARBOR LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5102
Mailing Address - Country:US
Mailing Address - Phone:763-383-5109
Mailing Address - Fax:763-383-2937
Practice Address - Street 1:3001 HARBOR LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5102
Practice Address - Country:US
Practice Address - Phone:763-383-5109
Practice Address - Fax:763-383-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty