24D0887975 CLIA NUMBER - WELLNESS & LONGEVITY CENTER

Laboratory Demographics

CLIA Number: 24D0887975

Facility Name: WELLNESS & LONGEVITY CENTER

Facility Address:
C/O HALL FAMILY CHIROPRACTIC AND WELLNESS CENTER 13999 60TH STREET NORTH
STILLWATER, MN
ZIP 55082
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Facility Phone Number: 651 439-1013

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1306941406

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	24D0887975
LAB Type	Practitioner Other
Facility Name	WELLNESS & LONGEVITY CENTER
Street	C/O HALL FAMILY CHIROPRACTIC AND WELLNESS CENTER 13999 60TH STREET NORTH
City	STILLWATER
State	MN
ZIP	55082
Phone	651 439-1013
CertificateType	4
CertificateEffectiveDate	6/21/2022
CertificateExpirationDate	6/20/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024