Provider Demographics
NPI:1417347899
Name:LIFECLINIC CHIROPRACTIC OF TEXAS, LLC
Entity Type:Organization
Organization Name:LIFECLINIC CHIROPRACTIC OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/D.C
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-868-6894
Mailing Address - Street 1:33 HAMLINE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2231
Mailing Address - Country:US
Mailing Address - Phone:952-229-7925
Mailing Address - Fax:952-474-1504
Practice Address - Street 1:971 SAM RAYBURN TOLLWAY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6004
Practice Address - Country:US
Practice Address - Phone:952-229-7925
Practice Address - Fax:952-474-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN03221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty