Provider Demographics
NPI:1689979098
Name:PREMIER LIFE CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:PREMIER LIFE CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-431-2220
Mailing Address - Street 1:7000 151ST ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5985
Mailing Address - Country:US
Mailing Address - Phone:952-431-2220
Mailing Address - Fax:952-431-2882
Practice Address - Street 1:7000 151ST ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5985
Practice Address - Country:US
Practice Address - Phone:952-431-2220
Practice Address - Fax:952-431-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty