Provider Demographics
NPI:1639349046
Name:LIFE CENTER FOR HEALTH
Entity Type:Organization
Organization Name:LIFE CENTER FOR HEALTH
Other - Org Name:ROSS LIFE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:BELNAP
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-661-9476
Mailing Address - Street 1:31882 DEL OBISPO STREET
Mailing Address - Street 2:SUITE 158
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3225
Mailing Address - Country:US
Mailing Address - Phone:949-661-9476
Mailing Address - Fax:949-661-7536
Practice Address - Street 1:31882 DEL OBISPO ST
Practice Address - Street 2:SUITE 158
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3225
Practice Address - Country:US
Practice Address - Phone:949-661-9476
Practice Address - Fax:949-661-7536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15026111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15026Medicare PIN