Provider Demographics
NPI:1962865568
Name:BEACH LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:BEACH LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-697-8535
Mailing Address - Street 1:2100 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2948
Mailing Address - Country:US
Mailing Address - Phone:310-697-8535
Mailing Address - Fax:
Practice Address - Street 1:2100 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2948
Practice Address - Country:US
Practice Address - Phone:310-697-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty