MEDICARE: VITALIFE CHIROPRACTIC OF PAYNESVILLE, PLLC

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

General Provider Information

NPI Number	:	1346840733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALIFE CHIROPRACTIC OF PAYNESVILLE, PLLC

Provider Business Mailing Address
First Line	:	208 W JAMES ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362-1219
Country	:	US
Telephone Number	:	320-243-7412
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 W JAMES ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362-1219
Country	:	US
Telephone Number	:	320-243-7412
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	MRS. COURTNEY ERIN STENGER
Credential	:	DC
Telephone Number	:	320-248-0040

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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