Organization Active NPI

Live Well Adjusted, P.a.

  • Rehabilitation Chiropractor
  • Woodbury, MN
National Provider Identifier
1447853585
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
Legal business name
LIVE WELL ADJUSTED, P.A.
Practice address
7803 Afton Rd Ste 2
Woodbury, MN 55125-1507
Phone
(651) 261-5020
NPI assigned
Nov 20, 2020
Last updated
Nov 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Authorized official

Name
Sandy Peterson
Title
Office Coordinator
Phone
(651) 261-5020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X NU Primary

Addresses

Primary practice location

7803 Afton Rd Ste 2
Woodbury, MN 55125-1507

Mailing address

7803 Afton Rd Ste 2
Woodbury, MN 55125-1507
Phone (651) 261-5020

Other identifiers 1

IdentifierTypeStateIssuer
7096887OtherMNMINNESOTA REGISTRATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210216002932 MN Part B Supplier - Clinic/Group Practice 5991110355 Receives reassigned benefits from 1 practitioner
Practice locations: Woodbury, MN

National Provider Directory

National Provider Directory

Locations

7803 Afton Rd
Ste 2
Woodbury, MN 55125
Phone (651) 261-5020

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1447853585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7803 AFTON RD STE 2",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251507",
            "telephone_number": "651-261-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7803 AFTON RD STE 2",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251507",
            "telephone_number": "651-261-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE WELL ADJUSTED, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-20",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "OFFICE COORDINATOR",
        "authorized_official_telephone_number": "651-261-5020"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA REGISTRATION",
            "identifier": "7096887",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.