Organization
NORTHERN LIFE CHIROPRACTIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA FAWN SHAFIEI (ACCOUNT EXECUTIVE)
(952) 890-0804
Entity
Organization
Contact information
Practice address
13955 W PRESERVE BLVD # 200, BURNSVILLE, MN 55337-7733
(952) 890-0804
(952) 890-1095
Mailing address
13955 W PRESERVE BLVD # 200, BURNSVILLE, MN 55337-7733
(952) 890-0804
(952) 890-1095
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302103300
—
MN
01
—
38B71NO
BCBS ID NUMBER
MN
Enumeration date
10/03/2006
Last updated
04/03/2014
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