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Contact Information

EAGLE TRACE WELLNESS CENTER, PA
12002 COUNTY ROAD 11
BURNSVILLE, MN55337-3016
 Phone: 952-808-2922
 Fax: 952-808-2910
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Chiropractor

111N00000X 35 Chiropractic
 

Acupuncturist

171100000X
Indicates primary specialty

NPI Profile & details for EAGLE TRACE WELLNESS CENTER, PA

NPI Number 1790932390
LBN Legal business name EAGLE TRACE WELLNESS CENTER, PA
Authorized official ELISA KENSINGER - (VICE PRESIDENT, SECRETARY, TREASURE)
Entity Organization
Organization subpart 1 No
Enumeration date 08/26/2008
Last updated 08/26/2008 - About 18 years ago
Identifiers
MN License # 5077
MN License # 5104
MN License # 832
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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