Provider Demographics
NPI:1619322625
Name:CIRCLE OF LIFE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-253-5567
Mailing Address - Street 1:3156 ROUTE 88
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2885
Mailing Address - Country:US
Mailing Address - Phone:732-295-4000
Mailing Address - Fax:
Practice Address - Street 1:3156 ROUTE 88
Practice Address - Street 2:SUITE 1
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2885
Practice Address - Country:US
Practice Address - Phone:732-295-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00725800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty