Provider Demographics
NPI:1164451357
Name:LIFE CHIROPRACTIC CENTER P.C
Entity Type:Organization
Organization Name:LIFE CHIROPRACTIC CENTER P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-327-0888
Mailing Address - Street 1:6334 W SAGINAW HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2487
Mailing Address - Country:US
Mailing Address - Phone:517-327-0888
Mailing Address - Fax:517-327-0802
Practice Address - Street 1:6334 W SAGINAW HWY
Practice Address - Street 2:SUITE H
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2487
Practice Address - Country:US
Practice Address - Phone:517-327-0888
Practice Address - Fax:517-327-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4752059Medicaid
MI4752059Medicaid