Provider Demographics
NPI:1912300013
Name:ALLIED WELLNESS PROFESSIONALS, PLLC
Entity Type:Organization
Organization Name:ALLIED WELLNESS PROFESSIONALS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:HASTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-249-3816
Mailing Address - Street 1:2459 - 15TH STREET NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2345
Mailing Address - Country:US
Mailing Address - Phone:651-249-3816
Mailing Address - Fax:
Practice Address - Street 1:2459 - 15TH STREET NW
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2345
Practice Address - Country:US
Practice Address - Phone:651-249-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty