Provider Demographics
NPI:1164493763
Name:A NEW LIFE CHIROPRACTIC & MASSAGE, PC
Entity Type:Organization
Organization Name:A NEW LIFE CHIROPRACTIC & MASSAGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CLIFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-230-5500
Mailing Address - Street 1:3487 S LINDEN RD
Mailing Address - Street 2:SUITE V
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3025
Mailing Address - Country:US
Mailing Address - Phone:810-230-5500
Mailing Address - Fax:810-230-2895
Practice Address - Street 1:3487 S LINDEN RD
Practice Address - Street 2:SUITE V
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3025
Practice Address - Country:US
Practice Address - Phone:810-230-5500
Practice Address - Fax:810-230-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU80564Medicare UPIN
MION12330Medicare ID - Type UnspecifiedMEDICARE NUMBER