Provider Demographics
NPI:1144735960
Name:CUTTING EDGE WELLNESS LLC
Entity type:Organization
Organization Name:CUTTING EDGE WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-762-2639
Mailing Address - Street 1:507 N NOKOMIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2353
Mailing Address - Country:US
Mailing Address - Phone:320-762-2639
Mailing Address - Fax:320-762-2650
Practice Address - Street 1:507 N NOKOMIS ST STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2353
Practice Address - Country:US
Practice Address - Phone:320-762-2639
Practice Address - Fax:320-762-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty