Provider Demographics
NPI:1174857668
Name:CENTER FOR LIFE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CENTER FOR LIFE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-312-9794
Mailing Address - Street 1:1004 NW MILWAUKEE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2243
Mailing Address - Country:US
Mailing Address - Phone:541-312-9794
Mailing Address - Fax:541-312-9795
Practice Address - Street 1:1004 NW MILWAUKEE AVE
Practice Address - Street 2:STE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2243
Practice Address - Country:US
Practice Address - Phone:541-312-9794
Practice Address - Fax:541-312-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty