Provider Demographics
NPI:1326180860
Name:TREE OF LIFE CHIROPRACTIC CLINIC P.A.
Entity Type:Organization
Organization Name:TREE OF LIFE CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEDIDIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-345-8244
Mailing Address - Street 1:1001 TWELVE OAKS CENTER DRIVE
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-345-8244
Mailing Address - Fax:763-546-8793
Practice Address - Street 1:1001 TWELVE OAKS CENTER DRIVE
Practice Address - Street 2:SUITE 1015
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-345-8244
Practice Address - Fax:763-546-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8603611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
122231OtherHEALTH PARTNERS PROVIDER
4402834OtherMEDICA PROVIDER
979T7TROtherBCBS GROUP PROVIDER
MN554327400Medicaid
230439OtherACN PROVIDER
MNT39558MNMedicare UPIN
4402834OtherMEDICA PROVIDER