Life Chiropractic: a Wellness Centre, P.c.

NPI #1811142300 in Wayzata, Minnesota

Provider Information

NPI Number: 1811142300
Entity Type: Organization
Organization Name: Life Chiropractic: a Wellness Centre, P.c.
Primary Specialty: Chiropractor
Enumeration Date: Nov 25, 2008
Last Updated: Nov 25, 2008

Practice Location

Address: 109 BUSHAWAY RD
Address 2: SUITE 100
City: Wayzata
State: Minnesota
ZIP Code: 55391-1945
Phone: (952) 746-5352

Authorized Official

Name: DR. REGGIE STANLEY FULLER, D.C.
Title: CHIROPRACTOR/PRESIDENT
Phone: (952) 746-5352

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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