Provider Demographics
NPI:1871784272
Name:LIFEFORCE FAMILY CHIROPRACTIC PA
Entity type:Organization
Organization Name:LIFEFORCE FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ARNETT
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC,ICPA
Authorized Official - Phone:952-746-4404
Mailing Address - Street 1:8734 W COUNTY RD 42
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-746-4404
Mailing Address - Fax:
Practice Address - Street 1:8734 COUNTY ROAD 42 W
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2561
Practice Address - Country:US
Practice Address - Phone:952-746-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN458967000Medicaid
MN350003382Medicare UPIN