Provider Demographics
NPI:1841612736
Name:WELLSPRING CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:WELLSPRING CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESTBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-571-1345
Mailing Address - Street 1:6425 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5128
Mailing Address - Country:US
Mailing Address - Phone:763-571-1345
Mailing Address - Fax:763-571-2291
Practice Address - Street 1:6425 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5128
Practice Address - Country:US
Practice Address - Phone:763-571-1345
Practice Address - Fax:763-571-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350000743OtherMEDICARE IDENTIFICATION NUMBER
MN350000743OtherMEDICARE IDENTIFICATION NUMBER