Provider Demographics
NPI:1508191255
Name:HEALTH WELLNESS CENTER MANAGEMENT LLC
Entity Type:Organization
Organization Name:HEALTH WELLNESS CENTER MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LESKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-562-2420
Mailing Address - Street 1:6500 BARRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2348
Mailing Address - Country:US
Mailing Address - Phone:952-562-2420
Mailing Address - Fax:952-562-2421
Practice Address - Street 1:6500 BARRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2348
Practice Address - Country:US
Practice Address - Phone:952-562-2420
Practice Address - Fax:952-562-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3891111N00000X
MN3031111N00000X
MN6346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty