Provider Demographics
NPI:1205933231
Name:NEW LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:NEW LIFE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DACBR
Authorized Official - Phone:972-899-8002
Mailing Address - Street 1:2628 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4839
Mailing Address - Country:US
Mailing Address - Phone:972-899-8002
Mailing Address - Fax:972-899-8003
Practice Address - Street 1:2628 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4839
Practice Address - Country:US
Practice Address - Phone:972-899-8002
Practice Address - Fax:972-899-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11117111N00000X
TX6315111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00361X TXMedicare PIN
TX605687Medicare UPIN