Provider Demographics
NPI:1568832871
Name:GOOD LIFE CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:GOOD LIFE CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-847-8308
Mailing Address - Street 1:855 SAM NEWELL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7593
Mailing Address - Country:US
Mailing Address - Phone:704-847-8308
Mailing Address - Fax:704-841-1819
Practice Address - Street 1:855 SAM NEWELL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7593
Practice Address - Country:US
Practice Address - Phone:704-847-8308
Practice Address - Fax:704-841-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty