Provider Demographics
NPI:1962667006
Name:QUALITY LIFE CHIROPRACTIC & MASSAGE, P.A.
Entity Type:Organization
Organization Name:QUALITY LIFE CHIROPRACTIC & MASSAGE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNTKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-206-6334
Mailing Address - Street 1:3249 19TH ST NW
Mailing Address - Street 2:STE 2
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6799
Mailing Address - Country:US
Mailing Address - Phone:507-206-6334
Mailing Address - Fax:507-206-6339
Practice Address - Street 1:3249 19TH ST NW
Practice Address - Street 2:STE 2
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6799
Practice Address - Country:US
Practice Address - Phone:507-206-6334
Practice Address - Fax:507-206-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty