Provider Demographics
NPI:1083897243
Name:URWC, PA
Entity Type:Organization
Organization Name:URWC, PA
Other - Org Name:UPPER ROOM WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:CONNERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-739-1248
Mailing Address - Street 1:1654 COUNTY ROAD E E
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4637
Mailing Address - Country:US
Mailing Address - Phone:651-739-1248
Mailing Address - Fax:651-264-9844
Practice Address - Street 1:1654 COUNTY ROAD E E
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-4637
Practice Address - Country:US
Practice Address - Phone:651-739-1248
Practice Address - Fax:651-264-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN344J1COOtherBLUE CROSS
MN123840OtherHEALTHPARTNERS
MN399527500Medicaid
MN350056695OtherRAILROAD MEDICARE
MN123840OtherHEALTHPARTNERS
MN344J1COOtherBLUE CROSS