Provider Demographics
NPI:1407106354
Name:DISCOVER LIFE PC
Entity Type:Organization
Organization Name:DISCOVER LIFE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-622-0075
Mailing Address - Street 1:2956 GINNALA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2956 GINNALA DR STE 102
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7825
Practice Address - Country:US
Practice Address - Phone:970-622-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty