Provider Demographics
NPI:1770048027
Name:HEALING RIVER CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:HEALING RIVER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-439-3737
Mailing Address - Street 1:1903 GREELEY ST S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5298
Mailing Address - Country:US
Mailing Address - Phone:651-439-3737
Mailing Address - Fax:651-438-3334
Practice Address - Street 1:1903 GREELEY ST S STE 100
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6066
Practice Address - Country:US
Practice Address - Phone:651-439-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty