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General NPI Number Information
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NPI Number | 1508245747
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Entity Type | Organization
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Legal Business Name | LIFELONG HEALTH FMAILY CHIROPRACTIC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1121 JACKSON ST NE 111
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1672
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Country | US
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Telephone | 612-354-2213
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 JACKSON ST NE 111
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1672
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Country | US
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Telephone | 612-354-2213
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIN ANDERSON
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Credential | D.C.
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Telephone | 612-354-2231
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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 | 6085
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License Number State | MN
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