Provider Demographics
NPI:1558123604
Name:LIFE FAMILY CHIROPRACTIC OF FARMINGTON LLC
Entity Type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC OF FARMINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-384-0494
Mailing Address - Street 1:14 ELY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1707
Mailing Address - Country:US
Mailing Address - Phone:860-384-0494
Mailing Address - Fax:
Practice Address - Street 1:2 SPRING LN UNIT 4
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3306
Practice Address - Country:US
Practice Address - Phone:860-470-7114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty