Provider Demographics
NPI:1629531884
Name:WELLNESS 4 LIFE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WELLNESS 4 LIFE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-370-3237
Mailing Address - Street 1:834 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2027
Mailing Address - Country:US
Mailing Address - Phone:563-370-3237
Mailing Address - Fax:
Practice Address - Street 1:575 10TH ST SW STE 5
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3906
Practice Address - Country:US
Practice Address - Phone:563-223-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center