Provider Demographics
NPI:1255751244
Name:GRACE CHIROPRACTIC AND WELLNESS PLLC
Entity type:Organization
Organization Name:GRACE CHIROPRACTIC AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ALSCHLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-747-7874
Mailing Address - Street 1:13405 OLIVER AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2063
Mailing Address - Country:US
Mailing Address - Phone:612-747-7874
Mailing Address - Fax:
Practice Address - Street 1:18476 KENRICK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9288
Practice Address - Country:US
Practice Address - Phone:612-747-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty