Provider Demographics
NPI:1205074416
Name:FAMILY LIFESTYLE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:FAMILY LIFESTYLE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:RIBELLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-766-8428
Mailing Address - Street 1:305 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1719
Practice Address - Country:US
Practice Address - Phone:509-766-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602889847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty