Provider Demographics
NPI:1407489404
Name:LIFE CHIROPRACTIC AND WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:LIFE CHIROPRACTIC AND WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ZUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-366-3636
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-0028
Mailing Address - Country:US
Mailing Address - Phone:989-366-3636
Mailing Address - Fax:
Practice Address - Street 1:320 N HURON ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1513
Practice Address - Country:US
Practice Address - Phone:231-597-9393
Practice Address - Fax:231-597-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty