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General NPI Number Information
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NPI Number | 1326180860
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE CHIROPRACTIC CLINIC P.A.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 1001 TWELVE OAKS CENTER DRIVE SUITE 1015
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City | WAYZATA
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State | MN
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Zip | 55391
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Country | US
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Telephone | 952-345-8244
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Fax | 763-546-8793
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Provider Business Mailing Address
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Address Line | 1001 TWELVE OAKS CENTER DRIVE SUITE 1015
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City | WAYZATA
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State | MN
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Zip | 55391
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Country | US
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Telephone | 952-345-8244
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Fax | 763-546-8793
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. JEDIDIAH KRAUSS
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Credential | D.C.
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Telephone | 952-345-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 8603611
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License Number State | MN
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