Provider Demographics
NPI:1982744140
Name:GOLDEN SUN CHIROPRACTIC WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:GOLDEN SUN CHIROPRACTIC WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:UNA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-922-1478
Mailing Address - Street 1:6009 WAYZATA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2675
Mailing Address - Country:US
Mailing Address - Phone:952-922-1478
Mailing Address - Fax:952-922-0248
Practice Address - Street 1:220 W 98TH ST STE 7
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2000
Practice Address - Country:US
Practice Address - Phone:952-922-1478
Practice Address - Fax:952-922-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7482281-00Medicaid
MN350003100Medicare ID - Type Unspecified
MNU19484Medicare UPIN