LIFE CHIROPRACTIC: A WELLNESS CENTRE, P.C. (NPI# 1811142300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811142300 |
| Entity Type | Organization |
| Organization Name | LIFE CHIROPRACTIC: A WELLNESS CENTRE, P.C. |
| Practice Address |
109 Bushaway Rd Suite 100 Wayzata MN 55391-1945 |
| Practice Telephone | 9527465352 |
| Practice Fax Number | 9527465097 |
| Mailing Telephone | 9527465352 |
| Mailing Fax Number | 9527465097 |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-11-25 |
| Authorized Official Name | DR. REGGIE STANLEY FULLER (CHIROPRACTOR/PRESIDENT) |
| Authorized Official Telephone | 9527465352 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 5014 | MN | Chiropractic Providers |
| Street Address |
109 BUSHAWAY RD SUITE 100 |
| City | WAYZATA |
| State | MN |
| Zip Code | 55391-1945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730182270 | George Harold Landis | Surgery | 109 Bushaway Rd, Suite 200, Wayzata, MN 55391-1945 | 2005-05-29 |
| 1568809697 | Thomas Patrick Stecker | Chiropractor | 109 Bushaway Rd, Suite #100, Wayzata, MN 55391-1945 | 2013-05-30 |
| 1952657124 | Nicole Holmes | Dentist | 109 Bushaway Rd, Suite 300, Wayzata, MN 55391-1945 | 2012-07-25 |
| 1801183082 | Julia Ann Herman | Dentist | 109 Bushaway Rd, Suite 300, Wayzata, MN 55391-1945 | 2011-07-07 |
| 1861792376 | Simona Rae Whiley | Massage Therapist | 109 Bushaway Rd, Suite 200, Wayzata, MN 55391-1945 | 2010-10-31 |
| 1932373180 | James Nehl Mckone | Dentist | 109 Bushaway Rd, Suite 300, Wayzata, MN 55391-1945 | 2008-04-18 |
| 1851569883 | Rajni Shah | Optometrist | 109 Bushaway Rd, Ste 300, Wayzata, MN 55391-1945 | 2008-02-12 |
| 1255533667 | Northland Billing Services | Contractor | 109 Bushaway Rd, Suite 300, Wayzata, MN 55391-1945 | 2007-06-05 |
| 1265509350 | Landis Plastic Surgery P C | Surgery | 109 Bushaway Rd, Suite 200, Wayzata, MN 55391-1945 | 2006-11-30 |
| 1922185016 | Lake Minnetonka Dental | Dentist | 109 Bushaway Rd, Suite 300, Wayzata, MN 55391-1945 | 2006-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386456 | Alexandra Lloyd Conroy | Counselor | 3227 Lake Shore Boulevard, Minnetonka, MN 55391 | 2020-11-07 |
| 1417579178 | Kate Anne Schroeder | Behavioral Analyst | 901 Twelve Oaks Center Drive Suite 934, Wayzata, MN 55391 | 2020-05-15 |
| 1467940478 | Tyler Michael Knutson | Chiropractor | 1421 E Wayzata Blvd, Wayzata, MN 55391 | 2018-04-25 |
| 1427552025 | Emma Nadler, L.L.C. | Counselor | 700 Twelve Oaks Center Dr. #263, Wayzata, MN 55391 | 2018-03-20 |
| 1730687757 | Global Home Care Inc | Home Health | 1001 Twelve Oaks Center Drive, Suite 1018, Wayzata, MN 55391 | 2018-01-24 |
| 1205362472 | Oraphanh Vongpheth Smith | Registered Nurse | 801 Twelve Oaks Center Drive, Suite 822, Wayzata, MN 55391 | 2017-05-10 |
| 1386189272 | Wayzata Endodontics, P.a. | Dentist | 101 Lake Street West, Suite 100, Wayzata, MN 55391 | 2016-12-30 |
| 1952763351 | Watershed Psychological Services | Clinic/Center | 4255 Pheasant Ridge Drive, Suite 412, Blaine, MN 55391 | 2016-03-24 |
| 1477923571 | Robert J. Floren | Marriage & Family Therapist | 801 Twelve Oaks Center Dr Ste 816a, Wayzata, MN 55391 | 2015-10-01 |
| 1194101055 | Bruce Martinson Family & Cosmetic Dentistry | Dentist | 317 E Wayzata Blvd, Wayzata, MN 55391 | 2015-08-03 |
| Find all providers in zip 55391 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144844598 | Christian Allen Johnson | Chiropractor | 18202 Minnetonka Blvd Ste 101a, Wayzata, MN 55391-4136 | 2020-06-02 |
| 1255983490 | Michael Rees | Chiropractor | 1133 Wayzata Blvd E Ste B, Wayzata, MN 55391-1950 | 2019-07-09 |
| 1467940478 | Tyler Michael Knutson | Chiropractor | 1421 E Wayzata Blvd, Wayzata, MN 55391 | 2018-04-25 |
| 1497153852 | Nicholas Wegleitner | Chiropractor | 18202 Minnetonka Blvd, Suite 101a, Wayzata, MN 55391-3343 | 2014-12-16 |
| 1356607238 | Chiropractic Concepts LLC | Chiropractor | 3311 County Road 101 S Ste 2, Wayzata, MN 55391-2879 | 2012-04-05 |
| 1669763827 | Brewer Corp Pa | Chiropractor | 3800 Shoreline Dr., Wayzata, MN 55391-9785 | 2011-04-22 |
| 1699920249 | Vitality Chiropractic: A Wellness Guide Centre P.C. | Chiropractor | 935 Wayzata Blvd E, Suite 100, Wayzata, MN 55391-1849 | 2008-11-24 |
| 1588831697 | Wayzata Chiropractic Clinic | Chiropractor | 101 Lake St W Ste 100, Wayzata, MN 55391-1577 | 2008-05-08 |
| 1366637092 | Rose Ellen Shultz Boyd | Chiropractor | 1310 E. Wayzata Bvld, Wayzata, MN 55391-1952 | 2007-09-06 |
| 1265637979 | Bradley J Molskness | Chiropractor | 18142 Minnetonka Blvd, Wayzata, MN 55391-3327 | 2007-06-20 |
| Find all providers in WAYZATA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.