Provider Demographics
NPI:1205196151
Name:NEW LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NEW LIFE CHIROPRACTIC LLC
Other - Org Name:WYLIE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-442-5800
Mailing Address - Street 1:611 S HIGHWAY 78 STE 104
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4046
Mailing Address - Country:US
Mailing Address - Phone:972-442-5800
Mailing Address - Fax:
Practice Address - Street 1:611 S HIGHWAY 78 STE 104
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4046
Practice Address - Country:US
Practice Address - Phone:972-442-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty