Provider Demographics
NPI:1477899722
Name:GOOD LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GOOD LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MENGES-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-469-2657
Mailing Address - Street 1:12511 MEDINAH RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4127
Mailing Address - Country:US
Mailing Address - Phone:719-469-2657
Mailing Address - Fax:
Practice Address - Street 1:7495 MCLAUGHLIN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4706
Practice Address - Country:US
Practice Address - Phone:719-469-2657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty