Life Clinic of Mo DC PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LIFE CLINIC OF MO DC PC

Practice address

2051 South Lindbergh Blvd
Frontenac, MO 63131

Phone

(952) 229-7464

NPI assigned

Nov 20, 2019

Last updated

Jan 17, 2022By 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

Reza Alizadeh, DCNPI 1538214598

Title

President

Phone

(612) 868-6894

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 5

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.

• Trenton Parker Civello, DC

  • Chiropractor
  • Frontenac, MO
  • NPI 1497319628
  Medicare reassignment Care Compare group NPD
• Paige M Luth, DC

  • Chiropractor
  • Frontenac, MO
  • NPI 1821701566
  Medicare reassignment Care Compare group NPD
• Madison Kay Roberts

  • Chiropractor
  • Washington, MO
  • NPI 1588294920
  Medicare reassignment Care Compare group NPD
• Michael Schneider, DC

  • Chiropractor
  • Saint Peters, MO
  • NPI 1760074827
  Medicare reassignment Care Compare group NPD
• Reza Pour Alizadeh, D.C.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1538214598
  NPD (past) Authorized official

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642377600000",
    "number": "1891331369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553170549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 SOUTH LINDBERGH BLVD",
            "city": "FRONTENAC",
            "state": "MO",
            "postal_code": "63131",
            "telephone_number": "952-229-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC OF MO DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A",
        "authorized_official_last_name": "ALIZADEH",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-868-6894",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellie Huff, RD, LD, CSCS
• Gerald Louis Keller Jr., CRNFA
• Jennifer Kraemer, DPT
• Evan Kuhl, PT, DPT, XPS, USAW-1
• Kunj Govind Patel MD LLC, a Series LLC (Center for Regenerative and Interventional Spine and Sports Pain)
• Paige M Luth, DC
• Jennifer Nicole Mahoney, RD
• Lauren McGaughey, PA-C
• Melanie Melissa Miranda, WHNP-BC
• Nra-St. Louis (Home Therapy Center), Missouri, LLC (Frontenac Home Dialysis Center)

• Chiropractor in Frontenac, MO
• Providers in Frontenac, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.