Provider Demographics
NPI:1699106773
Name:LIFE WELLNESS CENTER-EAGAN, PA
Entity type:Organization
Organization Name:LIFE WELLNESS CENTER-EAGAN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-435-5300
Mailing Address - Street 1:1895 PLAZA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4600
Mailing Address - Country:US
Mailing Address - Phone:651-688-8886
Mailing Address - Fax:651-688-2702
Practice Address - Street 1:1895 PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4600
Practice Address - Country:US
Practice Address - Phone:651-688-8886
Practice Address - Fax:651-688-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty