Provider Demographics
NPI:1639578164
Name:GOODLIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:GOODLIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELIE
Authorized Official - Last Name:CARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-543-7779
Mailing Address - Street 1:1300 S PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5003
Mailing Address - Country:US
Mailing Address - Phone:310-543-7779
Mailing Address - Fax:310-961-5942
Practice Address - Street 1:1300 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5003
Practice Address - Country:US
Practice Address - Phone:310-543-7779
Practice Address - Fax:310-961-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty