Provider Demographics
NPI:1710404843
Name:PURE LIFE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:PURE LIFE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-744-6565
Mailing Address - Street 1:8090 N 85TH WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4344
Mailing Address - Country:US
Mailing Address - Phone:480-744-6565
Mailing Address - Fax:
Practice Address - Street 1:8090 N 85TH WAY STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4344
Practice Address - Country:US
Practice Address - Phone:480-744-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty