Provider Demographics
NPI:1427209527
Name:A HEALTHY LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:A HEALTHY LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-988-9004
Mailing Address - Street 1:1005 E BDWY
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-2004
Mailing Address - Country:US
Mailing Address - Phone:865-988-9004
Mailing Address - Fax:865-988-0042
Practice Address - Street 1:1005 E BDWY
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-2004
Practice Address - Country:US
Practice Address - Phone:865-988-9004
Practice Address - Fax:865-988-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU75211OtherUPIN
TN3128665OtherBCBS
TN7695120OtherAETNA
4308504OtherCIGNA
4308504OtherCIGNA