Provider Demographics
NPI:1952583171
Name:HEALTHWAYS CHIROPRACTIC AND INTEGRATED WELLNESS CENTER
Entity Type:Organization
Organization Name:HEALTHWAYS CHIROPRACTIC AND INTEGRATED WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-388-5315
Mailing Address - Street 1:121 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3579
Mailing Address - Country:US
Mailing Address - Phone:507-388-5315
Mailing Address - Fax:507-388-2699
Practice Address - Street 1:121 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3579
Practice Address - Country:US
Practice Address - Phone:507-388-5315
Practice Address - Fax:507-388-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33057COOtherBCBS LEGACY
MN33057COOtherBCBS LEGACY