Provider Demographics
NPI:1962568576
Name:LIFEWAY CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:LIFEWAY CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-508-2454
Mailing Address - Street 1:7300 147TH ST W STE 101
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7541
Mailing Address - Country:US
Mailing Address - Phone:612-508-2454
Mailing Address - Fax:612-429-6791
Practice Address - Street 1:7300 147TH ST W STE 101
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7541
Practice Address - Country:US
Practice Address - Phone:612-508-2454
Practice Address - Fax:612-429-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV02445Medicare UPIN
MNU70189Medicare UPIN