Organization
LIFECLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REZA ALIZADEH DC (CEO)
(612) 868-6894
Entity
Organization
Contact information
Practice address
5525 CEDAR LAKE RD S, ST LOUIS PARK, MN 55416-1420
(952) 229-7901
Mailing address
33 HAMLINE AVE S, SAINT PAUL, MN 55105-2231
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
3112
MN
225100000X
Physical Therapist
8737
MN
Other
Enumeration date
07/31/2014
Last updated
07/31/2014
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