Provider Demographics
NPI:1922546522
Name:TREE OF LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TREE OF LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-501-7211
Mailing Address - Street 1:1101 W HIBISCUS BLVD
Mailing Address - Street 2:#105
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2718
Mailing Address - Country:US
Mailing Address - Phone:321-501-7211
Mailing Address - Fax:
Practice Address - Street 1:1101 W HIBISCUS BLVD
Practice Address - Street 2:#105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2718
Practice Address - Country:US
Practice Address - Phone:321-501-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty