Provider Demographics
NPI:1679029185
Name:LIFE EXPRESSIONS CHIROPRACTIC
Entity Type:Organization
Organization Name:LIFE EXPRESSIONS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMAGLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-413-3232
Mailing Address - Street 1:307 WEST ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8413
Mailing Address - Country:US
Mailing Address - Phone:417-413-3232
Mailing Address - Fax:
Practice Address - Street 1:307 WEST ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8413
Practice Address - Country:US
Practice Address - Phone:417-413-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015015989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty