Provider Demographics
NPI:1992189542
Name:SOUTH METRO WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:SOUTH METRO WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-892-5006
Mailing Address - Street 1:14031 BURNHAVEN DR
Mailing Address - Street 2:100
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4473
Mailing Address - Country:US
Mailing Address - Phone:952-892-5006
Mailing Address - Fax:952-892-5008
Practice Address - Street 1:14031 BURNHAVEN DR
Practice Address - Street 2:100
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4473
Practice Address - Country:US
Practice Address - Phone:952-892-5006
Practice Address - Fax:952-892-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty