Provider Demographics
NPI:1417415449
Name:SERVICE FOR LIFE INC
Entity Type:Organization
Organization Name:SERVICE FOR LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRIST
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-385-8807
Mailing Address - Street 1:95 MOONSTONE CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3748
Mailing Address - Country:US
Mailing Address - Phone:386-631-5627
Mailing Address - Fax:
Practice Address - Street 1:532 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7012
Practice Address - Country:US
Practice Address - Phone:386-385-8807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty