Provider Demographics
NPI:1316086416
Name:LIFEFORCE CHIROPRACTIC PA
Entity type:Organization
Organization Name:LIFEFORCE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WILHELMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-822-7509
Mailing Address - Street 1:3706 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1237
Mailing Address - Country:US
Mailing Address - Phone:612-822-7509
Mailing Address - Fax:612-827-3860
Practice Address - Street 1:3706 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1237
Practice Address - Country:US
Practice Address - Phone:612-822-7509
Practice Address - Fax:612-827-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413092800OtherMN DHS
MN155L8LIOtherBCBS GROUP#
MNC03420Medicare PIN