Provider Demographics
NPI:1275192197
Name:SPECIFIC HEALTH & CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SPECIFIC HEALTH & CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-289-0344
Mailing Address - Street 1:2785 WHITE BEAR AVE N STE 108
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1320
Mailing Address - Country:US
Mailing Address - Phone:651-415-0418
Mailing Address - Fax:651-415-0106
Practice Address - Street 1:2785 WHITE BEAR AVE N STE 108
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1320
Practice Address - Country:US
Practice Address - Phone:651-415-0418
Practice Address - Fax:651-415-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty