Provider Demographics
NPI:1811408339
Name:LIFE CHIROPRACTIC OF OLNEY, LLC
Entity Type:Organization
Organization Name:LIFE CHIROPRACTIC OF OLNEY, LLC
Other - Org Name:LIFE CHIROPRACTIC CLINIC OF OLNEY,
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STREAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-924-6444
Mailing Address - Street 1:18120 HILLCREST AVE STE D
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1444
Mailing Address - Country:US
Mailing Address - Phone:301-924-6444
Mailing Address - Fax:301-774-3033
Practice Address - Street 1:18120 HILLCREST AVE STE D
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1444
Practice Address - Country:US
Practice Address - Phone:301-924-6444
Practice Address - Fax:301-924-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03726111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty