Provider Demographics
NPI:1629477013
Name:IHS OF WOODBURY PA
Entity Type:Organization
Organization Name:IHS OF WOODBURY PA
Other - Org Name:HEALTHSOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-731-1880
Mailing Address - Street 1:1754 OLD HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6118
Mailing Address - Country:US
Mailing Address - Phone:612-708-1067
Mailing Address - Fax:
Practice Address - Street 1:1754 OLD HUDSON RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6118
Practice Address - Country:US
Practice Address - Phone:612-708-1067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty