MEDICARE: CONNECTED LIFE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1518546910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTED LIFE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2510 14TH AVE NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-7732
Country	:	US
Telephone Number	:	507-993-9398
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 37TH ST NE STE 200
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-5438
Country	:	US
Telephone Number	:	507-218-7822
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAYLA ANN NEUVILLE
Credential	:	DC
Telephone Number	:	507-993-9398

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	04/05/2021

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Directions to “CONNECTED LIFE CHIROPRACTIC LLC ” Practice Location

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