Provider Demographics
NPI:1780040659
Name:EPIC LIFE CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:EPIC LIFE CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-839-8884
Mailing Address - Street 1:26421 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4528
Mailing Address - Country:US
Mailing Address - Phone:248-905-5066
Mailing Address - Fax:248-905-5069
Practice Address - Street 1:869 SAINT FRANCOIS ST
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4923
Practice Address - Country:US
Practice Address - Phone:314-839-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty