NPIMap

Organization Active NPI

Lifeclinic PA

  • Rehabilitation Chiropractor
  • St Louis Park, MN
National Provider Identifier
1922416064
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
3112 Issued in MN
Legal business name
LIFECLINIC PA
Practice address
5525 Cedar Lake Rd S
St Louis Park, MN 55416-1420
Phone
(952) 229-7901
NPI assigned
Jul 31, 2014
Last updated
Jul 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Authorized official

Name
Reza Alizadeh, DCNPI 1538214598
Title
Ceo
Phone
(612) 868-6894

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X 3112 MN Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 8737 MN

Addresses

Primary practice location

5525 Cedar Lake Rd S
St Louis Park, MN 55416-1420

Mailing address

33 Hamline Ave S
Saint Paul, MN 55105-2231

National Provider Directory

National Provider Directory
Tax ID family
Life Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

675 Commons Dr
Woodbury, MN 55125
Phone (651) 501-5459

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1922416064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 HAMLINE AVE S",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 CEDAR LAKE RD S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161420",
            "telephone_number": "952-229-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "ALIZADEH",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-868-6894",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MN",
            "license": "3112",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "8737",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.