Provider Demographics
NPI:1174668511
Name:PURELIFE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PURELIFE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-434-2080
Mailing Address - Street 1:217 E SPRINGBROOK DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1733
Mailing Address - Country:US
Mailing Address - Phone:217-434-2080
Mailing Address - Fax:
Practice Address - Street 1:217 E SPRINGBROOK DR
Practice Address - Street 2:SUITE #1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1733
Practice Address - Country:US
Practice Address - Phone:217-434-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty