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General NPI Number Information
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NPI Number | 1770850489
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Entity Type | Organization
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Legal Business Name | HEALTHY FOR LIFE FAMILY WELLNESS CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 9336 ENSIGN AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55438-1455
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Country | US
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Telephone | 952-829-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 9641 BRIGHTON LN
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-3131
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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 | DOCTOR OF CHIROPRACTIC
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Name | DR. KEVIN JOESPH UNTERREINER
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Credential | D.C.
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Telephone | 952-829-0100
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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 | 3251
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License Number State | MN
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