Provider Demographics
NPI:1477945418
Name:RISVOLD CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:RISVOLD CHIROPRACTIC AND WELLNESS
Other - Org Name:WELL ADJUSTED MINNEAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RISVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-501-2430
Mailing Address - Street 1:5900 PAINTER RD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8200
Mailing Address - Country:US
Mailing Address - Phone:612-501-2430
Mailing Address - Fax:
Practice Address - Street 1:126 N 3RD ST
Practice Address - Street 2:SUITE 504
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1658
Practice Address - Country:US
Practice Address - Phone:612-501-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty