Provider Demographics
NPI:1306555719
Name:NEW LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NEW LIFE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:AIMEE CAROLYN
Authorized Official - Last Name:VEENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-675-9828
Mailing Address - Street 1:17595 KENWOOD TRL STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7319
Mailing Address - Country:US
Mailing Address - Phone:651-401-6494
Mailing Address - Fax:651-401-6468
Practice Address - Street 1:17595 KENWOOD TRL STE 120
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7319
Practice Address - Country:US
Practice Address - Phone:651-401-6494
Practice Address - Fax:651-401-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty