Provider Demographics
NPI:1710337167
Name:THE WELLNESS WAY COTTAGE GROVE LLC
Entity Type:Organization
Organization Name:THE WELLNESS WAY COTTAGE GROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-660-7877
Mailing Address - Street 1:7145 E POINT DOUGLAS RD S
Mailing Address - Street 2:STE 150
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3045
Mailing Address - Country:US
Mailing Address - Phone:651-340-4000
Mailing Address - Fax:
Practice Address - Street 1:7145 E POINT DOUGLAS RD S
Practice Address - Street 2:STE 150
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3045
Practice Address - Country:US
Practice Address - Phone:651-340-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty