Wellness & Longevity Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2810 Issued in MN

Legal business name

WELLNESS & LONGEVITY CENTER

Practice address

1530 Frontage Rd W
Valley Ridge Mall
Stillwater, MN 55082-2102

Phone

(651) 439-1013

Fax

(651) 439-3465

NPI assigned

Sep 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sandra Lea Spore, DCNPI 1659312668

Title

Clinic Director

Phone

(651) 439-1013

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Sandra Lea Spore, RN DC DABCI DACBN

  • Chiropractor
  • Stillwater, MN
  • NPI 1659312668
  Authorized official Same address or phone

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306941406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 FRONTAGE RD W",
            "address_2": "VALLEY RIDGE MALL",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550822102",
            "telephone_number": "651-439-1013",
            "fax_number": "651-439-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 FRONTAGE RD W",
            "address_2": "VALLEY RIDGE MALL",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550822102",
            "telephone_number": "651-439-1013",
            "fax_number": "651-439-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS & LONGEVITY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SPORE",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "651-439-1013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond Watts, MD
• Matthew Kane Weber, DC
• Lily Weidall, RN
• Bethany Weir
• Lindsay Wellbrock
• Laura McKee Welp, LICSW, LADC
• Chad Joseph Wert, D.D.S
• Donald Walter Theisen Wessel, MD
• Kristin West, PT
• Patricia J Whitney, PT

• Chiropractor in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.