MEDICARE: ACTIVE LIVING CHIROPRACTIC P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	4818	MN

General Provider Information

NPI Number	:	1093738692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE LIVING CHIROPRACTIC P.A.

Provider Business Mailing Address
First Line	:	2211 W 82ND ST
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-1306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 ARBORETUM BLVD
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386
Country	:	US
Telephone Number	:	952-240-3564
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TRACY MARIE BURMEISTER
Credential	:	D.C.
Telephone Number	:	952-240-3564

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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