Life Chiropractic: a Wellness Centre, P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5014 Issued in MN

Legal business name

LIFE CHIROPRACTIC: A WELLNESS CENTRE, P.C.

Practice address

109 Bushaway Rd
Suite 100
Wayzata, MN 55391-1945

Phone

(952) 746-5352

Fax

(952) 746-5097

NPI assigned

Nov 25, 2008

Last updated

Nov 25, 2008By 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. Reggie Stanley Fuller, D.C.

Title

Chiropractor/President

Phone

(952) 746-5352

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1227571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227571200000",
    "number": "1811142300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 BUSHAWAY RD",
            "address_2": "SUITE 100",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911945",
            "telephone_number": "952-746-5352",
            "fax_number": "952-746-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 BUSHAWAY RD",
            "address_2": "SUITE 100",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911945",
            "telephone_number": "952-746-5352",
            "fax_number": "952-746-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHIROPRACTIC: A WELLNESS CENTRE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-25",
        "last_updated": "2008-11-25",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "REGGIE",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "CHIROPRACTOR/PRESIDENT",
        "authorized_official_telephone_number": "952-746-5352",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Lawson
• Christina Sunkyong Lee, LAC
• Dukhyung Lee, MSW
• Ann Leland
• Kelsey Lien, MD
• Life Rehab Services, Inc.
• Debra B. Lindell, MA, LAMFT
• Char Lo, CNP
• Kerin E Logstrom, MA, LMFT
• Andrew Dean Lonnquist, D.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; 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.