Provider Demographics
NPI:1336650043
Name:WELLNESS WAY EDEN PRAIRIE LLC
Entity Type:Organization
Organization Name:WELLNESS WAY EDEN PRAIRIE LLC
Other - Org Name:WELLNESS WAY BLOOMINGTON LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-660-7877
Mailing Address - Street 1:6805 FLYING CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3418
Mailing Address - Country:US
Mailing Address - Phone:952-255-6980
Mailing Address - Fax:
Practice Address - Street 1:6805 FLYING CLOUD DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3418
Practice Address - Country:US
Practice Address - Phone:952-255-6980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty