Provider Demographics
NPI:1558377929
Name:LIFE FAMILY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:POCHUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-429-3015
Mailing Address - Street 1:1060 CENTERVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6344
Mailing Address - Country:US
Mailing Address - Phone:651-429-3015
Mailing Address - Fax:651-653-3832
Practice Address - Street 1:1060 CENTERVILLE CIR
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-6344
Practice Address - Country:US
Practice Address - Phone:651-429-3015
Practice Address - Fax:651-653-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty