Provider Demographics
NPI:1417156415
Name:GOOD LIFE INC
Entity Type:Organization
Organization Name:GOOD LIFE INC
Other - Org Name:GOOD LIFE FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRAGOITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-551-9950
Mailing Address - Street 1:3624 W ANTHEM WAY
Mailing Address - Street 2:SUITE C-110
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3624 W ANTHEM WAY
Practice Address - Street 2:SUITE C-110
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0440
Practice Address - Country:US
Practice Address - Phone:623-551-9950
Practice Address - Fax:623-551-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 7399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU98697Medicare UPIN
Z 77718Medicare PIN
AZZ 77718Medicare PIN
AZU98426Medicare UPIN