Provider Demographics
NPI:1508402074
Name:LIFE CHIROPRACTIC AND INJURY CENTER LLC
Entity Type:Organization
Organization Name:LIFE CHIROPRACTIC AND INJURY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-467-5600
Mailing Address - Street 1:6103 BALTIMORE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1966
Mailing Address - Country:US
Mailing Address - Phone:240-467-5600
Mailing Address - Fax:240-467-5626
Practice Address - Street 1:6103 BALTIMORE AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1966
Practice Address - Country:US
Practice Address - Phone:240-467-5600
Practice Address - Fax:240-467-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty