Provider Demographics
NPI:1932426509
Name:FULL LIFE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:FULL LIFE CHIROPRACTIC PLLC
Other - Org Name:UNITED HEALTH CHIROPRACTIC PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-232-2662
Mailing Address - Street 1:3212 14TH AVENUE SOUTH, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6306
Mailing Address - Country:US
Mailing Address - Phone:701-232-2662
Mailing Address - Fax:701-232-9588
Practice Address - Street 1:3212 14TH AVENUE SOUTH, SUITE 2
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6306
Practice Address - Country:US
Practice Address - Phone:701-232-2662
Practice Address - Fax:701-232-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND859261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care