Provider Demographics
NPI:1427182666
Name:CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-380-0477
Mailing Address - Street 1:205 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-380-0477
Mailing Address - Fax:251-380-0478
Practice Address - Street 1:205 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-380-0477
Practice Address - Fax:251-380-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK218Medicare ID - Type UnspecifiedCORP GROUP ID #