Organization
REVITALIFE CENTER, P.A.
Active
Other names
RevitaLife Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LINDA PHAM D.C. (OWNER/CHIROPRACTOR)
(763) 710-4085
Entity
Organization
Contact information
Practice address
8097 HIGHWAY 65 NE STE 102, SPRING LAKE PARK, MN 55432-4511
(763) 710-4085
Mailing address
8097 HIGHWAY 65 NE STE 102, SPRING LAKE PARK, MN 55432-4511
(763) 710-4085
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5552
MN
Other
Enumeration date
12/13/2011
Last updated
10/25/2012
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