Provider Demographics
NPI:1518205293
Name:BREATH OF LIFE
Entity Type:Organization
Organization Name:BREATH OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:760-945-1345
Mailing Address - Street 1:161 THUNDER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6016
Mailing Address - Country:US
Mailing Address - Phone:760-945-1345
Mailing Address - Fax:760-945-1377
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-945-1345
Practice Address - Fax:760-945-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty