Provider Demographics
NPI:1801827472
Name:CHIROPRACTIC FIRST LIFE
Entity Type:Organization
Organization Name:CHIROPRACTIC FIRST LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-424-1142
Mailing Address - Street 1:8600 W STATE ROAD 84 STE C
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4558
Mailing Address - Country:US
Mailing Address - Phone:954-424-1142
Mailing Address - Fax:954-424-1143
Practice Address - Street 1:8600 W STATE ROAD 84 STE C
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4558
Practice Address - Country:US
Practice Address - Phone:954-424-1142
Practice Address - Fax:954-424-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55284OtherBLUE CROSS BLUE SHIELD
FL55284AMedicare ID - Type Unspecified
FL55284OtherBLUE CROSS BLUE SHIELD