Provider Demographics
NPI:1386947869
Name:SUMMIT CHIROPRACTIC AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILES
Authorized Official - Middle Name:
Authorized Official - Last Name:STIFTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCWP
Authorized Official - Phone:763-515-6177
Mailing Address - Street 1:10904 57TH ST NE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4658
Mailing Address - Country:US
Mailing Address - Phone:763-515-6177
Mailing Address - Fax:763-515-6199
Practice Address - Street 1:10904 57TH ST NE
Practice Address - Street 2:SUITE 107
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4658
Practice Address - Country:US
Practice Address - Phone:763-515-6177
Practice Address - Fax:763-515-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies