MEDICARE: HEALTHY LIFE CHIROPRACTIC & WELLNESS, LLC

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	111N00000X	Chiropractor	6261	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982146502	OTHER	MN	NPI

General Provider Information

NPI Number	:	1235653726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIFE CHIROPRACTIC & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2209 RIVER HILLS DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1170
Country	:	US
Telephone Number	:	952-838-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	4078 W COUNTY ROAD 42
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-2023
Country	:	US
Telephone Number	:	952-838-5233
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. NEVILLE LAMBOURNE
Credential	:	DC
Telephone Number	:	952-882-4654

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	02/09/2021

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