Provider Demographics
NPI:1386842888
Name:LIFE HEALTH, INC
Entity Type:Organization
Organization Name:LIFE HEALTH, INC
Other - Org Name:BORGESON CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BORGESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-594-3505
Mailing Address - Street 1:719 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-3015
Mailing Address - Country:US
Mailing Address - Phone:785-594-3505
Mailing Address - Fax:785-594-3853
Practice Address - Street 1:719 HIGH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-3015
Practice Address - Country:US
Practice Address - Phone:785-594-3505
Practice Address - Fax:785-594-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005473Medicare ID - Type Unspecified
KST42333Medicare UPIN
KS0004941Medicare ID - Type Unspecified