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General NPI Number Information
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NPI Number | 1558377929
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Entity Type | Organization
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Legal Business Name | LIFE FAMILY CHIROPRACTIC, INC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1060 CENTERVILLE CIR
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-6344
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Country | US
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Telephone | 651-429-3015
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Fax | 651-653-3832
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Provider Business Mailing Address
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Address Line | 1060 CENTERVILLE CIR
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-6344
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Country | US
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Telephone | 651-429-3015
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Fax | 651-653-3832
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Authorized Official
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Title or Position | CEO
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Name | DR. NATHANIEL ELI POCHUCHA
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Credential | D.C.
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Telephone | 651-429-3015
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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 | 4771
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License Number State | MN
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