Provider Demographics
NPI:1255834909
Name:DESIGNED LIFE CHIROPRACTIC PS
Entity Type:Organization
Organization Name:DESIGNED LIFE CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KILPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-604-2829
Mailing Address - Street 1:785 CANYON ST APT 206
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2909 S QUILLAN ST STE 158
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2437
Practice Address - Country:US
Practice Address - Phone:541-604-2829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty