Provider Demographics
NPI:1245401710
Name:NEW LIFE CHIROPRACTIC CLUB LLC
Entity Type:Organization
Organization Name:NEW LIFE CHIROPRACTIC CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAZIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-776-1880
Mailing Address - Street 1:6555 POWERLINE RD
Mailing Address - Street 2:103
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2067
Mailing Address - Country:US
Mailing Address - Phone:954-776-1880
Mailing Address - Fax:954-776-1808
Practice Address - Street 1:6555 POWERLINE RD
Practice Address - Street 2:103
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2067
Practice Address - Country:US
Practice Address - Phone:954-776-1880
Practice Address - Fax:954-776-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty