MEDICARE: HEALTHY FOR LIFE FAMILY WELLNESS 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	111N00000X	Chiropractor	3251	MN

General Provider Information

NPI Number	:	1770850489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY FOR LIFE FAMILY WELLNESS CHIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	9641 BRIGHTON LN
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-3131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9336 ENSIGN AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1455
Country	:	US
Telephone Number	:	952-829-0100
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. KEVIN JOESPH UNTERREINER
Credential	:	D.C.
Telephone Number	:	952-829-0100

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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