Provider Demographics
NPI:1598991002
Name:CRANIAL LIFE FORCE CENTER, INC.
Entity Type:Organization
Organization Name:CRANIAL LIFE FORCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOEPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-353-1819
Mailing Address - Street 1:485 HUNTINGTON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-1861
Mailing Address - Country:US
Mailing Address - Phone:706-353-1819
Mailing Address - Fax:706-353-1802
Practice Address - Street 1:485 HUNTINGTON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1861
Practice Address - Country:US
Practice Address - Phone:706-353-1819
Practice Address - Fax:706-353-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty