Provider Demographics
NPI:1700093911
Name:COMPLETE HEALTH CENTER PA
Entity Type:Organization
Organization Name:COMPLETE HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PUETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-532-4355
Mailing Address - Street 1:111 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258
Mailing Address - Country:US
Mailing Address - Phone:507-532-4355
Mailing Address - Fax:507-532-2399
Practice Address - Street 1:111 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-532-4355
Practice Address - Fax:507-532-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN639625900Medicaid
MN90D32COOtherBLUE CROSS BLUE SHIELD
MN90D32COOtherBLUE CROSS BLUE SHIELD
MN350002227Medicare ID - Type Unspecified