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General NPI Number Information
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NPI Number | 1699106773
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Entity Type | Organization
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Legal Business Name | LIFE WELLNESS CENTER-EAGAN, PA
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Dates
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Enumeration Date | 11/27/2013
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 1895 PLAZA DR SUITE 200
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City | EAGAN
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State | MN
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Zip | 55122-4600
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Country | US
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Telephone | 651-688-8886
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Fax | 651-688-2702
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Provider Business Mailing Address
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Address Line | 1895 PLAZA DR SUITE 200
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City | EAGAN
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State | MN
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Zip | 55122-4600
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Country | US
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Telephone | 651-688-8886
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Fax | 651-688-2702
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS SCHMIDT
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Credential | DC
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Telephone | 952-435-5300
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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