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General NPI Number Information
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NPI Number | 1558636225
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Entity Type | Organization
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Legal Business Name | DISCOVER LIFE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 4820 W 77TH ST SUITE 130
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City | EDINA
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State | MN
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Zip | 55435-4815
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Country | US
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Telephone | 952-426-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 W 77TH ST SUITE 130
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City | EDINA
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State | MN
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Zip | 55435-4815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATHIAS PAMER
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Credential | D.C.
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Telephone | 419-529-2706
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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 | 4968
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License Number State | MN
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