Provider Demographics
NPI:1790187508
Name:PENTZ FAMILY CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:PENTZ FAMILY CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-591-1985
Mailing Address - Street 1:1706 OLD TROLLEY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9035
Mailing Address - Country:US
Mailing Address - Phone:843-879-9824
Mailing Address - Fax:
Practice Address - Street 1:1706 OLD TROLLEY RD
Practice Address - Street 2:SUITE F
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9035
Practice Address - Country:US
Practice Address - Phone:843-879-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty