Provider Demographics
NPI:1033558168
Name:INSPIRED LIFE WELLNESS CLINIC, PLLC
Entity Type:Organization
Organization Name:INSPIRED LIFE WELLNESS CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GETZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:BSNRN
Authorized Official - Phone:701-989-4345
Mailing Address - Street 1:804 TOWER PL
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3244
Mailing Address - Country:US
Mailing Address - Phone:701-989-4354
Mailing Address - Fax:701-425-0104
Practice Address - Street 1:3100 MOONSTONE LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6308
Practice Address - Country:US
Practice Address - Phone:701-989-4354
Practice Address - Fax:701-213-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center