Provider Demographics
NPI:1629591979
Name:LIFE REFINED CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LIFE REFINED CHIROPRACTIC, LLC
Other - Org Name:LIFE REFINED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-674-8857
Mailing Address - Street 1:14297 BERGEN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3383
Mailing Address - Country:US
Mailing Address - Phone:317-674-8857
Mailing Address - Fax:
Practice Address - Street 1:14214 VALLEY CREST CT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46040
Practice Address - Country:US
Practice Address - Phone:701-340-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY IMPACT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002871A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty