Provider Demographics
NPI:1740787449
Name:LIFE SOURCE, A PARLETT CORPORATION
Entity Type:Organization
Organization Name:LIFE SOURCE, A PARLETT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-266-7799
Mailing Address - Street 1:12153 MIDDLEBROOK SQ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3756
Mailing Address - Country:US
Mailing Address - Phone:858-231-0304
Mailing Address - Fax:
Practice Address - Street 1:844 W SAN MARCOS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1137
Practice Address - Country:US
Practice Address - Phone:760-266-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty