Provider Demographics
NPI:1396893533
Name:STILLWATER NATURAL HEALTH CARE INC.
Entity type:Organization
Organization Name:STILLWATER NATURAL HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-439-6285
Mailing Address - Street 1:215 WILLIAM ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4723
Mailing Address - Country:US
Mailing Address - Phone:651-439-6285
Mailing Address - Fax:651-439-6290
Practice Address - Street 1:215 WILLIAM ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4723
Practice Address - Country:US
Practice Address - Phone:651-439-6285
Practice Address - Fax:651-439-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU37041Medicare UPIN
MN350002973Medicare ID - Type Unspecified