Provider Demographics
NPI:1467714964
Name:LIFE AGAIN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:LIFE AGAIN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:206-724-1843
Mailing Address - Street 1:365 RENTON CENTER WAY SW
Mailing Address - Street 2:STE. F
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2324
Mailing Address - Country:US
Mailing Address - Phone:425-226-7061
Mailing Address - Fax:
Practice Address - Street 1:365 RENTON CENTER WAY SW
Practice Address - Street 2:STE. F
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2324
Practice Address - Country:US
Practice Address - Phone:425-226-7061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty