Provider Demographics
NPI:1447797162
Name:FINISH LINE WELLNESS
Entity Type:Organization
Organization Name:FINISH LINE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDBOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-746-4162
Mailing Address - Street 1:4401 EGAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2024
Mailing Address - Country:US
Mailing Address - Phone:952-746-4162
Mailing Address - Fax:952-808-3112
Practice Address - Street 1:4401 EGAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2024
Practice Address - Country:US
Practice Address - Phone:952-746-4162
Practice Address - Fax:952-808-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty