Organization
PURE LIFE CHIROPRACTIC AND WELLNESS CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS RYAN JOHNSON D.C. (PRESIDENT/OWNER)
(320) 864-6249
Entity
Organization
Contact information
Practice address
920 10TH ST E, GLENCOE, MN 55336-2301
(320) 864-6249
(320) 864-6243
Mailing address
920 10TH ST E, GLENCOE, MN 55336-2301
(320) 864-6249
(320) 864-6243
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
5603
MN
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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