Provider Demographics
NPI:1467471433
Name:ANNE M. WERNER D.C.,P.A.
Entity Type:Organization
Organization Name:ANNE M. WERNER D.C.,P.A.
Other - Org Name:COUNTRYSIDE CHIROPRACTIC & MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-829-0262
Mailing Address - Street 1:7700 W OLD SHAKOPEE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-3302
Mailing Address - Country:US
Mailing Address - Phone:952-829-0262
Mailing Address - Fax:952-829-0237
Practice Address - Street 1:7700 W OLD SHAKOPEE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-3302
Practice Address - Country:US
Practice Address - Phone:952-829-0262
Practice Address - Fax:952-829-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNBLUECROSS BLUE SHIELOther162D0WE
MNCO4038Medicare ID - Type Unspecified