Provider Demographics
NPI:1013643725
Name:LIFE FAMILY CHIROPRACTIC OF VENICE LLC
Entity Type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC OF VENICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-384-0494
Mailing Address - Street 1:101 CHARDIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:860-384-0494
Mailing Address - Fax:860-677-1139
Practice Address - Street 1:101 CHARDIN DRIVE
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275
Practice Address - Country:US
Practice Address - Phone:860-384-0494
Practice Address - Fax:860-677-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty