NPIMap

Organization Active NPI

Lifetime Wellness Center, P.a.

  • Chiropractor
  • Plymouth, MN
National Provider Identifier
1265465934
Registry record updated Aug 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4505 Issued in MN
Legal business name
LIFETIME WELLNESS CENTER, P.A.
Practice address
14215 44TH PL N
#6
Plymouth, MN 55446-2344
Phone
(763) 559-5627
NPI assigned
Jul 8, 2006
Last updated
Aug 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jesse C. Ploessl, D.C.NPI 1831122597
Title
President
Phone
(763) 559-5627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4505 MN Primary

Addresses

Primary practice location

14215 44TH PL N
#6
Plymouth, MN 55446-2344

Mailing address

14215 44TH PL N
#6
Plymouth, MN 55446-2344
Phone (763) 559-5627

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188432000000",
    "number": "1265465934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14215 44TH PL N",
            "address_2": "#6",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462344",
            "telephone_number": "763-559-5627",
            "fax_number": "763-559-5627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14215 44TH PL N",
            "address_2": "#6",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462344",
            "telephone_number": "763-559-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME WELLNESS CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-08-30",
        "status": "A",
        "authorized_official_last_name": "PLOESSL",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-559-5627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.