Provider Demographics
NPI:1801961826
Name:GRAND HEALTH CHIROPRACTIC AND WELLNESS CENTER, P.A.
Entity type:Organization
Organization Name:GRAND HEALTH CHIROPRACTIC AND WELLNESS CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-228-9000
Mailing Address - Street 1:1025 SELBY AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6533
Mailing Address - Country:US
Mailing Address - Phone:651-228-9000
Mailing Address - Fax:651-224-2806
Practice Address - Street 1:1025 SELBY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6533
Practice Address - Country:US
Practice Address - Phone:651-228-9000
Practice Address - Fax:651-224-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5356111N00000X
MN5367111N00000X
MN3005261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C122MCOtherBC/BS
MNC04121Medicare ID - Type UnspecifiedGROUP ID #