Provider Demographics
NPI:1760012454
Name:NORTHWOOD CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:NORTHWOOD CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BEENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-432-3932
Mailing Address - Street 1:10900 89TH AVE N STE 1
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4027
Mailing Address - Country:US
Mailing Address - Phone:763-432-3932
Mailing Address - Fax:
Practice Address - Street 1:10900 89TH AVE N STE 1
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4027
Practice Address - Country:US
Practice Address - Phone:763-432-3932
Practice Address - Fax:763-432-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty