Provider Demographics
NPI:1083913602
Name:NEW LIFE FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:NEW LIFE FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-301-0110
Mailing Address - Street 1:2828 HIGHWAY 31 S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1510
Mailing Address - Country:US
Mailing Address - Phone:256-301-0110
Mailing Address - Fax:256-301-0116
Practice Address - Street 1:2828 HIGHWAY 31 S
Practice Address - Street 2:SUITE 104
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1510
Practice Address - Country:US
Practice Address - Phone:256-301-0110
Practice Address - Fax:256-301-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2214111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G351802OtherMEDICARE GROUP PTAN