Provider Demographics
NPI:1659731974
Name:LIFE FORCE CHIROPRACTIC OF PUYALLUP INC
Entity Type:Organization
Organization Name:LIFE FORCE CHIROPRACTIC OF PUYALLUP INC
Other - Org Name:LIFE FORCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-200-4401
Mailing Address - Street 1:13333 MERIDIAN E STE H
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-2405
Mailing Address - Country:US
Mailing Address - Phone:253-200-4401
Mailing Address - Fax:253-200-4402
Practice Address - Street 1:13333 MERIDIAN E STE H
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2405
Practice Address - Country:US
Practice Address - Phone:253-200-4401
Practice Address - Fax:253-200-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH80312800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty