Provider Demographics
NPI:1376696211
Name:LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-425-5433
Mailing Address - Street 1:99 WALL STREET
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-4312
Mailing Address - Country:US
Mailing Address - Phone:212-425-5433
Mailing Address - Fax:212-425-3337
Practice Address - Street 1:99 WALL STREET
Practice Address - Street 2:SUITE 1700
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-4312
Practice Address - Country:US
Practice Address - Phone:212-425-5433
Practice Address - Fax:212-425-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X6Z301Medicare ID - Type Unspecified
U99538Medicare UPIN