Provider Demographics
NPI:1568863405
Name:PW CLINIC PLLC
Entity Type:Organization
Organization Name:PW CLINIC PLLC
Other - Org Name:MINNETONKA CHIROPRACTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERDA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:925-236-7610
Mailing Address - Street 1:10653 WAYZATA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1543
Mailing Address - Country:US
Mailing Address - Phone:952-236-7610
Mailing Address - Fax:
Practice Address - Street 1:10653 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1543
Practice Address - Country:US
Practice Address - Phone:952-236-7610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty