Provider Demographics
NPI:1275705758
Name:HEALING CHOICES LLC
Entity Type:Organization
Organization Name:HEALING CHOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-241-5436
Mailing Address - Street 1:18140 ZANE ST NW # 303
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4505
Mailing Address - Country:US
Mailing Address - Phone:763-241-5436
Mailing Address - Fax:763-241-5466
Practice Address - Street 1:200 5TH ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1917
Practice Address - Country:US
Practice Address - Phone:763-241-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3500261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN407660000Medicaid
MNC03743OtherMEDICARE LEGACY
GADG5136OtherRAILROAD MEDICARE
MN132M0HEOtherBCBS