Provider Demographics
NPI:1851847032
Name:GOOD LIFE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GOOD LIFE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-413-8825
Mailing Address - Street 1:7011 KENTWELL LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6572
Mailing Address - Country:US
Mailing Address - Phone:402-413-8825
Mailing Address - Fax:
Practice Address - Street 1:7011 KENTWELL LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6572
Practice Address - Country:US
Practice Address - Phone:402-413-8825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty