Provider Demographics
NPI:1346443553
Name:COFFMAN CHIROPRACTIC LIFE CENTERS, P.C.
Entity Type:Organization
Organization Name:COFFMAN CHIROPRACTIC LIFE CENTERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-892-2717
Mailing Address - Street 1:4289 BONNY OAKS DR STE 107
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-1600
Mailing Address - Country:US
Mailing Address - Phone:423-892-2717
Mailing Address - Fax:423-892-9985
Practice Address - Street 1:4289 BONNY OAKS DR STE 107
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-1600
Practice Address - Country:US
Practice Address - Phone:423-892-2717
Practice Address - Fax:423-892-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3053339OtherBLUE CROSS BLUE SHIELD
TN3676374Medicaid
TN3676374Medicare ID - Type Unspecified
TN3676374Medicaid