Provider Demographics
NPI:1164882486
Name:PURE HEALTH LIFESTYLE INC.
Entity Type:Organization
Organization Name:PURE HEALTH LIFESTYLE INC.
Other - Org Name:PURE HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAINIER
Authorized Official - Last Name:SOLKAMANS
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:714-953-5533
Mailing Address - Street 1:2323 N. TUSTIN AVE.
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-953-5533
Mailing Address - Fax:714-550-7047
Practice Address - Street 1:2323 N TUSTIN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1606
Practice Address - Country:US
Practice Address - Phone:714-953-5533
Practice Address - Fax:714-550-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28174305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service