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Organization
YOUR LIFE CHIROPRACTIC, P.A.
Active
Organization
YOUR LIFE CHIROPRACTIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAUDIE RAE LOUISIANA D.C. (OWNER)
(763) 682-0611
Entity
Organization
Contact information
Practice address
103 CENTER DR, SUITE 200, BUFFALO, MN 55313-2957
(763) 682-0611
(763) 682-0788
Mailing address
103 CENTER DR, SUITE 200, BUFFALO, MN 55313-2957
(763) 682-0611
(763) 682-0788
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
581
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62M57DE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
02/14/2007
Last updated
08/22/2020
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