Provider Demographics
NPI:1508580978
Name:LIFE UNIVERSITY INC
Entity Type:Organization
Organization Name:LIFE UNIVERSITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-957-6068
Mailing Address - Street 1:225 CALLE DEL PARQUE
Mailing Address - Street 2:ANNEX BUILDING, SECOND FLOOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:787-957-6067
Mailing Address - Fax:
Practice Address - Street 1:225 CALLE DEL PARQUE
Practice Address - Street 2:ANNEX BUILDING, SECOND FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-957-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE UNIVERSITY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty