Organization
LIVING LIFE CHIROPRACTIC, PLLC
Active
Other names
Functional Chiropractic and Laser
Organization subpart
No
Provider details
NPI number
Authorized official
JAY E WANKEN DC (OWNER)
(612) 787-7246
Entity
Organization
Contact information
Practice address
1226 4TH AVE E STE 140, SHAKOPEE, MN 55379-3641
(612) 787-7246
Mailing address
1226 4TH AVE E STE 140, SHAKOPEE, MN 55379-3641
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
04/23/2019
Last updated
04/23/2019
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