Provider Demographics
NPI:1053653683
Name:SD NEUBAUER FAMILY HEALTH & WELLNESS, PLLC
Entity type:Organization
Organization Name:SD NEUBAUER FAMILY HEALTH & WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-558-8322
Mailing Address - Street 1:1429 POND CURV
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-3109
Mailing Address - Country:US
Mailing Address - Phone:612-558-8322
Mailing Address - Fax:
Practice Address - Street 1:1429 POND CURV
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-3109
Practice Address - Country:US
Practice Address - Phone:612-558-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty