Provider Demographics
NPI:1780681437
Name:BEMIDJI HEALTH AND WELLNESS CENTER, P.C.
Entity Type:Organization
Organization Name:BEMIDJI HEALTH AND WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSON-SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-444-8727
Mailing Address - Street 1:403 AMERICA AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3122
Mailing Address - Country:US
Mailing Address - Phone:218-444-8727
Mailing Address - Fax:218-444-8546
Practice Address - Street 1:403 AMERICA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3122
Practice Address - Country:US
Practice Address - Phone:218-444-8727
Practice Address - Fax:218-444-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN396L2BEOtherBLUE CROSS BLUE SHIELD
MN396L2BEOtherBLUE CROSS BLUE SHIELD