Provider Demographics
NPI:1184779621
Name:LIFE IS GOOD CHIROPRACTIC
Entity type:Organization
Organization Name:LIFE IS GOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-992-2929
Mailing Address - Street 1:HC 1 BOX 10
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-9660
Mailing Address - Country:US
Mailing Address - Phone:570-992-2929
Mailing Address - Fax:570-992-3221
Practice Address - Street 1:HC 1 BOX 10
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-9660
Practice Address - Country:US
Practice Address - Phone:570-992-2929
Practice Address - Fax:570-992-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007914L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9701133OtherGHI
PA819689OtherFIRST PRIORITY
PA1783617OtherAMERIHEALTH
PA2622014000OtherPERSONAL
PA099441Medicare ID - Type UnspecifiedMEDICARE
PA819689OtherFIRST PRIORITY