Provider Demographics
NPI:1710322086
Name:UPTOWN HEALING CLINIC LLC
Entity Type:Organization
Organization Name:UPTOWN HEALING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WURM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-886-9607
Mailing Address - Street 1:14440 28TH PL N
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4854
Mailing Address - Country:US
Mailing Address - Phone:612-353-4486
Mailing Address - Fax:612-886-1578
Practice Address - Street 1:14440 28TH PL N
Practice Address - Street 2:SUITE 200B
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4854
Practice Address - Country:US
Practice Address - Phone:612-353-4486
Practice Address - Fax:612-886-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty