Provider Demographics
NPI:1710251707
Name:THRIVING LIFE CARE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:THRIVING LIFE CARE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-329-9604
Mailing Address - Street 1:260 S SUNNYVALE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6273
Mailing Address - Country:US
Mailing Address - Phone:408-329-9604
Mailing Address - Fax:408-262-1321
Practice Address - Street 1:260 S SUNNYVALE AVE STE 1
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6273
Practice Address - Country:US
Practice Address - Phone:408-329-9604
Practice Address - Fax:408-262-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30196111N00000X
CA30364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty