Provider Demographics
NPI:1922230861
Name:POWER OF LIFE, LLC
Entity Type:Organization
Organization Name:POWER OF LIFE, LLC
Other - Org Name:POWER OF LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-331-4744
Mailing Address - Street 1:PO BOX 161085
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-7000
Mailing Address - Country:US
Mailing Address - Phone:440-331-4744
Mailing Address - Fax:
Practice Address - Street 1:19930 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1837
Practice Address - Country:US
Practice Address - Phone:440-331-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty