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General NPI Number Information
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NPI Number | 1689984023
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Entity Type | Organization
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Legal Business Name | PEAK CHIROPRACTIC AND WELLNESS
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 13925 52ND AVE N APT 1102
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City | PLYMOUTH
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State | MN
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Zip | 55446-1645
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Country | US
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Telephone | 763-772-5260
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Fax |
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Provider Business Mailing Address
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Address Line | 13925 52ND AVE N APT 1102
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City | PLYMOUTH
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State | MN
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Zip | 55446-1645
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Country | US
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Telephone | 763-772-5260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. THERESA LUCITO
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Credential | D.C.
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Telephone | 763-772-5260
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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 | 5159
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License Number State | MN
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