# LIFELINE CHIROPRACTIC , P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578621710
- **Authorized official:** DR. SCOTT DURICK HANSEN D.C. (PRESIDENT)
- **Authorized official phone:** (651) 735-9353

## Contact information

- **Practice address:** 2165 WOODLANE DR, SUITE 102, WOODBURY, MN 55125-2915
- **Practice address phone:** (651) 735-9353
- **Practice address fax:** (651) 735-8282
- **Mailing address:** 2165 WOODLANE DR, SUITE 102, WOODBURY, MN 55125-2915
- **Mailing address phone:** (651) 735-9353
- **Mailing address fax:** (651) 735-8282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 3994 | MN | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 09/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 007J2LI | BCBSMN | MN |
| 05 | — | 996448700 | — | MN |