Provider Demographics
NPI:1174254437
Name:PURA VIDA CHIROPRACTIC & WELLNESS, P.A.
Entity Type:Organization
Organization Name:PURA VIDA CHIROPRACTIC & WELLNESS, P.A.
Other - Org Name:PURA VIDA CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-708-1638
Mailing Address - Street 1:403 W BURNSVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2569
Mailing Address - Country:US
Mailing Address - Phone:952-895-4085
Mailing Address - Fax:
Practice Address - Street 1:403 W BURNSVILLE PKWY
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2569
Practice Address - Country:US
Practice Address - Phone:952-895-4085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-18
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center