Living Life Chiropractic, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LIVING LIFE CHIROPRACTIC, PLLC

Doing business as

Functional Chiropractic and Laser

Practice address

1226 4TH Ave E Ste 140
Shakopee, MN 55379-3641

Phone

(612) 787-7246

NPI assigned

Apr 23, 2019

Last updated

Apr 23, 2019By 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

Jay E Wanken, DCNPI 1245347905

Title

Owner

Phone

(612) 787-7246

Specialties & licenses 1

Addresses

Other names 1

• Functional Chiropractic and Laser Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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.

• Jay Eric Wanken, DC

  • Chiropractor
  • Shakopee, MN
  • NPI 1245347905
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1386208650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 4TH AVE E STE 140",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 4TH AVE E STE 140",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793641",
            "telephone_number": "612-787-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING LIFE CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "WANKEN",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-787-7246",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.fcandlaser.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "1226 4th Ave E Ste 140",
            "city": "Shakopee",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553793641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Functional Chiropractic and Laser",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.