Provider Demographics
NPI:1891571568
Name:LIFEPOWER CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:LIFEPOWER CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-280-0586
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0013
Mailing Address - Country:US
Mailing Address - Phone:315-280-0586
Mailing Address - Fax:315-282-2332
Practice Address - Street 1:135 N COURT ST
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-7713
Practice Address - Country:US
Practice Address - Phone:315-280-0586
Practice Address - Fax:315-282-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty