Healthcare Provider Details

I. General information

NPI: 1679937601
Provider Name (Legal Business Name): LIFECLINIC PHYSICAL THERAPY & CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 S DIXIE HWY
CORAL GABLES FL
33133-4824
US

IV. Provider business mailing address

PO BOX 686
CHANHASSEN MN
55317-0686
US

V. Phone/Fax

Practice location:
  • Phone: 786-437-4458
  • Fax: 952-658-2826
Mailing address:
  • Phone: 786-437-4458
  • Fax: 952-658-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. REZA POUR ALIZADEH
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 612-868-6894