Healthcare Provider Details

I. General information

NPI: 1295650463
Provider Name (Legal Business Name): LIFE EXPRESSIONS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N GRANDVIEW LN STE 204
BISMARCK ND
58503-0877
US

IV. Provider business mailing address

1655 N GRANDVIEW LN STE 204
BISMARCK ND
58503-0877
US

V. Phone/Fax

Practice location:
  • Phone: 701-223-8413
  • Fax: 701-425-0148
Mailing address:
  • Phone: 701-223-8413
  • Fax: 701-425-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MANDY JO DIETZ
Title or Position: AO, PROVIDER, CEO
Credential: DC
Phone: 701-223-8413