Provider Demographics
NPI:1326287681
Name:WORTHINGTON WELLNESS CENTER
Entity Type:Organization
Organization Name:WORTHINGTON WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-207-6536
Mailing Address - Street 1:3348 SHERMAN CT
Mailing Address - Street 2:UNIT 103
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-5006
Mailing Address - Country:US
Mailing Address - Phone:651-207-6536
Mailing Address - Fax:
Practice Address - Street 1:3348 SHERMAN CT
Practice Address - Street 2:UNIT 103
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5006
Practice Address - Country:US
Practice Address - Phone:651-207-6536
Practice Address - Fax:651-207-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5146261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service