Provider Demographics
NPI:1235653726
Name:HEALTHY LIFE CHIROPRACTIC & WELLNESS, LLC
Entity Type:Organization
Organization Name:HEALTHY LIFE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-882-4654
Mailing Address - Street 1:2209 RIVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1170
Mailing Address - Country:US
Mailing Address - Phone:952-838-5233
Mailing Address - Fax:
Practice Address - Street 1:4078 W COUNTY ROAD 42
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2023
Practice Address - Country:US
Practice Address - Phone:952-838-5233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1982146502OtherNPI