Provider Demographics
NPI:1063826071
Name:BRIGHT LIFE FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:BRIGHT LIFE FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-710-4106
Mailing Address - Street 1:3097 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1726
Mailing Address - Country:US
Mailing Address - Phone:616-710-4106
Mailing Address - Fax:616-710-4117
Practice Address - Street 1:3097 29TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1726
Practice Address - Country:US
Practice Address - Phone:616-710-4106
Practice Address - Fax:616-710-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty