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General NPI Number Information
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NPI Number | 1629531884
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Entity Type | Organization
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Legal Business Name | WELLNESS 4 LIFE CHIROPRACTIC, PC
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 575 10TH ST SW STE 5
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City | VALLEY CITY
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State | ND
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Zip | 58072-3906
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Country | US
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Telephone | 563-223-8343
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Fax |
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Provider Business Mailing Address
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Address Line | 834 7TH ST NW
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City | VALLEY CITY
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State | ND
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Zip | 58072-2027
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Country | US
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Telephone | 563-370-3237
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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. LAURA LASSITER
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Credential | DC
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Telephone | 563-370-3237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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