Provider Demographics
NPI:1770850489
Name:HEALTHY FOR LIFE FAMILY WELLNESS CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:HEALTHY FOR LIFE FAMILY WELLNESS CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOESPH
Authorized Official - Last Name:UNTERREINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-829-0100
Mailing Address - Street 1:9641 BRIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9336 ENSIGN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1455
Practice Address - Country:US
Practice Address - Phone:952-829-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002854Medicare PIN