Healthcare Provider Details

I. General information

NPI: 1164927273
Provider Name (Legal Business Name): PRINCIPLED LIVING PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 36TH AVE N STE B
NEW HOPE MN
55427-1776
US

IV. Provider business mailing address

9405 36TH AVE N STE B
NEW HOPE MN
55427-1776
US

V. Phone/Fax

Practice location:
  • Phone: 763-275-9099
  • Fax: 763-275-9095
Mailing address:
  • Phone: 763-275-9099
  • Fax: 763-275-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6364
License Number StateMN

VIII. Authorized Official

Name: DR. SAMUEL RINEHART
Title or Position: OWNER
Credential: DC
Phone: 763-275-9099