Provider Demographics
NPI:1457761801
Name:MINNESOTA NATURAL MEDICINE CENTER, PA
Entity type:Organization
Organization Name:MINNESOTA NATURAL MEDICINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUYSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-807-6817
Mailing Address - Street 1:8900 109TH AVE N
Mailing Address - Street 2:SUITE #700
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3164
Mailing Address - Country:US
Mailing Address - Phone:763-807-6817
Mailing Address - Fax:
Practice Address - Street 1:8900 109TH AVE N
Practice Address - Street 2:SUITE #700
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3164
Practice Address - Country:US
Practice Address - Phone:763-807-6817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty