Provider Demographics
NPI:1235610213
Name:NATURAL LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NATURAL LIFE CHIROPRACTIC LLC
Other - Org Name:NATURAL LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-628-5433
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-0005
Mailing Address - Country:US
Mailing Address - Phone:833-628-5433
Mailing Address - Fax:833-628-5433
Practice Address - Street 1:90971 S WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408-9206
Practice Address - Country:US
Practice Address - Phone:931-224-3893
Practice Address - Fax:541-747-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty