| Eagle Trace Wellness Center, Pa | |
|
12002 County Road 11, Burnsville, MN 55337-3016 | |
| (952) 808-2922 | |
| (952) 808-2910 |
| Full Name | Eagle Trace Wellness Center, Pa |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 12002 County Road 11, Burnsville, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790932390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 5077 (Minnesota) | Primary |
| 111N00000X | Chiropractor | 5104 (Minnesota) | Secondary |
| 171100000X | Acupuncturist | 832 (Minnesota) | Secondary |
| Provider Name | Jeffrey Robert Plaster |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1184146383 PECOS PAC ID: 0143564476 Enrollment ID: I20181127003183 |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Trace Wellness Center, Pa 12002 County Road 11, Burnsville, MN 55337-3016 Ph: (952) 808-2922 | Eagle Trace Wellness Center, Pa 12002 County Road 11, Burnsville, MN 55337-3016 Ph: (952) 808-2922 |
Mena Scanlon, DC Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 13114 Grand Ave, Burnsville, MN 55337 Phone: 605-731-9152 | |
Ms. Jennifer Nicole Mangan, DC Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 13955 W Preserve Blvd # 200, Burnsville, MN 55337 Phone: 952-890-0804 Fax: 952-890-1095 | |
Dr. Stephen Alexander Irestone, D.C., N.D. Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 11970 Portland Ave, Burnsville, MN 55337 Phone: 952-895-7270 Fax: 952-895-1086 | |
Dr. Thomas Alan Anderson, DC Chiropractor Medicare: Medicare Enrolled Practice Location: 2424 E 117th St, Burnsville, MN 55337 Phone: 952-894-5108 | |
Stacy Neal, DC Chiropractor Medicare: Medicare Enrolled Practice Location: 1602 Cliff Road East, Burnsville, MN 55337 Phone: 612-710-7756 | |
Amy Elizabeth Fitzgearlds, DC Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 511 County Road 42 E, Burnsville, MN 55306 Phone: 952-960-8120 | |
Kathleen Ann Bloom, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 1606 Cliff Rd E, Burnsville, MN 55337 Phone: 952-894-6300 Fax: 952-894-2601 |