Healthcare Provider Details

I. General information

NPI: 1992479786
Provider Name (Legal Business Name): LIFELONG HEALTH CHIROPRACTIC STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACKSON ST NE STE 111
MINNEAPOLIS MN
55413-3050
US

IV. Provider business mailing address

1121 JACKSON ST NE STE 111
MINNEAPOLIS MN
55413-3050
US

V. Phone/Fax

Practice location:
  • Phone: 612-354-2231
  • Fax:
Mailing address:
  • Phone: 612-354-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SHEENA LYNN YETTER
Title or Position: OWNER
Credential: DC
Phone: 612-396-4916