Provider Demographics
NPI:1497290274
Name:GOOD LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:GOOD LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-871-1200
Mailing Address - Street 1:280 E HAMILTON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0241
Mailing Address - Country:US
Mailing Address - Phone:408-871-1200
Mailing Address - Fax:
Practice Address - Street 1:280 E HAMILTON AVE STE E
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0241
Practice Address - Country:US
Practice Address - Phone:408-871-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811915655Medicare PIN