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General NPI Number Information
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NPI Number | 1447853585
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Entity Type | Organization
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Legal Business Name | LIVE WELL ADJUSTED, P.A.
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 7803 AFTON RD STE 2
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City | WOODBURY
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State | MN
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Zip | 55125-1507
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Country | US
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Telephone | 651-261-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 7803 AFTON RD STE 2
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City | WOODBURY
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State | MN
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Zip | 55125-1507
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Country | US
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Telephone | 651-261-5020
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Fax |
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | SANDY PETERSON
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Credential |
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Telephone | 651-261-5020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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