Organization
LIFE CHIROPRACTIC: A WELLNESS CENTRE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGGIE STANLEY FULLER D.C. (CHIROPRACTOR/PRESIDENT)
(952) 746-5352
Entity
Organization
Contact information
Practice address
109 BUSHAWAY RD, SUITE 100, WAYZATA, MN 55391-1945
(952) 746-5352
(952) 746-5097
Mailing address
109 BUSHAWAY RD, SUITE 100, WAYZATA, MN 55391-1945
(952) 746-5352
(952) 746-5097
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5014
MN
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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