Provider Demographics
NPI:1700408887
Name:LIFE UNIVERSITY, INC
Entity Type:Organization
Organization Name:LIFE UNIVERSITY, INC
Other - Org Name:LIFE CHIROPRACTIC CENTERS- ROSWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-426-2786
Mailing Address - Street 1:1415 BARCLAY CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2943
Mailing Address - Country:US
Mailing Address - Phone:770-426-2786
Mailing Address - Fax:770-792-6113
Practice Address - Street 1:1323 ROSWELL ROAD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:770-426-2946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE UNIVERSITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty