NPIMap

Organization Active NPI

Your Life Chiropractic, P.a.

  • Chiropractor
  • Buffalo, MN
National Provider Identifier
1891838728
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
581 Issued in MN
Legal business name
YOUR LIFE CHIROPRACTIC, P.A.
Practice address
103 Center Dr
Suite 200
Buffalo, MN 55313-2957
Phone
(763) 682-0611
Fax
(763) 682-0788
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Maudie Rae Louisiana, D.C.
Title
Owner
Phone
(763) 682-0611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 581 MN Primary

Addresses

Primary practice location

103 Center Dr
Suite 200
Buffalo, MN 55313-2957

Mailing address

103 Center Dr
Suite 200
Buffalo, MN 55313-2957
Phone (763) 682-0611

Other identifiers 1

IdentifierTypeStateIssuer
62M57DEOtherMNBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

103 Center Dr
Ste 200
Buffalo, MN 55313
Phone (763) 682-0611

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891838728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CENTER DR",
            "address_2": "SUITE 200",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553132957",
            "telephone_number": "763-682-0611",
            "fax_number": "763-682-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CENTER DR",
            "address_2": "SUITE 200",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553132957",
            "telephone_number": "763-682-0611",
            "fax_number": "763-682-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR LIFE CHIROPRACTIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOUISIANA",
        "authorized_official_first_name": "MAUDIE",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-682-0611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "62M57DE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.