Provider Demographics
NPI:1902085806
Name:DISCOVER CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:DISCOVER CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-529-2703
Mailing Address - Street 1:1107 HAZELTINE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-368-4700
Mailing Address - Fax:952-368-4742
Practice Address - Street 1:1107 HAZELTINE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1009
Practice Address - Country:US
Practice Address - Phone:952-368-4700
Practice Address - Fax:952-368-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4967111N00000X
MN4968111N00000X
OH2869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty