Northern Life Chiropractic, P.a.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

NORTHERN LIFE CHIROPRACTIC, P.A.

Practice address

13955 W Preserve Blvd # 200
Burnsville, MN 55337-7733

Phone

(952) 890-0804

Fax

(952) 890-1095

NPI assigned

Oct 3, 2006

Last updated

Apr 3, 2014By 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

Vanessa Fawn Shafiei

Title

Account Executive

Phone

(952) 890-0804

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1821182734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13955 W PRESERVE BLVD # 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553377733",
            "telephone_number": "952-890-0804",
            "fax_number": "952-890-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13955 W PRESERVE BLVD # 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553377733",
            "telephone_number": "952-890-0804",
            "fax_number": "952-890-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIFE CHIROPRACTIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "SHAFIEI",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "FAWN",
        "authorized_official_title_or_position": "ACCOUNT EXECUTIVE",
        "authorized_official_telephone_number": "952-890-0804"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID NUMBER",
            "identifier": "38B71NO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302103300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Burnsville, MN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; 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.