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Organization
LIFELINE CHIROPRACTIC , P.A.
Active
Organization
LIFELINE CHIROPRACTIC , P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT DURICK HANSEN D.C. (PRESIDENT)
(651) 735-9353
Entity
Organization
Contact information
Practice address
2165 WOODLANE DR, SUITE 102, WOODBURY, MN 55125-2915
(651) 735-9353
(651) 735-8282
Mailing address
2165 WOODLANE DR, SUITE 102, WOODBURY, MN 55125-2915
(651) 735-9353
(651) 735-8282
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3994
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007J2LI
BCBSMN
MN
05
—
996448700
—
MN
Enumeration date
12/04/2006
Last updated
09/30/2008
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