1538583554 NPI number — LIFE CHIROPRACTIC AND WELLNESS CENTER INC.

Table of content: AMANDA DUNCAN STROTHER RD (NPI 1417746793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538583554 NPI number — LIFE CHIROPRACTIC AND WELLNESS CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE CHIROPRACTIC AND WELLNESS CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538583554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRUDENVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48651-0028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-366-3636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1090 W HOUGHTON LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRUDENVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48651-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-366-3636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ZUBECK
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-366-3636

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com