Provider Demographics
NPI:1437698479
Name:NEW LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NEW LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-399-3602
Mailing Address - Street 1:14580 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9774
Mailing Address - Country:US
Mailing Address - Phone:740-399-3602
Mailing Address - Fax:
Practice Address - Street 1:14580 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9774
Practice Address - Country:US
Practice Address - Phone:740-399-3602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty