| Healthsource Of White Bear Lake, Pllc | |
|
4801 Highway 61 N, 105, White Bear Lake, MN 55110-2737 | |
| (651) 762-5433 | |
| (651) 762-7504 |
| Full Name | Healthsource Of White Bear Lake, Pllc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 4801 Highway 61 N, White Bear Lake, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073767372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 5114 (Minnesota) | Primary |
| Provider Name | Ty E Paulick |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1902071285 PECOS PAC ID: 0840369039 Enrollment ID: I20080514000126 |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource Of White Bear Lake, Pllc 4801 Highway 61 N, 105, White Bear Lake, MN 55110-2737 Ph: (651) 762-5433 | Healthsource Of White Bear Lake, Pllc 4801 Highway 61 N, 105, White Bear Lake, MN 55110-2737 Ph: (651) 762-5433 |
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