Provider Demographics
NPI:1306231402
Name:TESTAROSSA HEALTH, INC
Entity Type:Organization
Organization Name:TESTAROSSA HEALTH, INC
Other - Org Name:WALHALLA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-261-4553
Mailing Address - Street 1:201 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2218
Mailing Address - Country:US
Mailing Address - Phone:651-264-5553
Mailing Address - Fax:
Practice Address - Street 1:206 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-1931
Practice Address - Country:US
Practice Address - Phone:651-261-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty