Provider Demographics
NPI:1255735387
Name:EMPOWERED LIFE, PC
Entity type:Organization
Organization Name:EMPOWERED LIFE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SANCHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CACCP
Authorized Official - Phone:912-826-3482
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-1459
Mailing Address - Country:US
Mailing Address - Phone:912-826-3482
Mailing Address - Fax:
Practice Address - Street 1:812 TOWNE PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9364
Practice Address - Country:US
Practice Address - Phone:912-826-3482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009190111NN0400X, 111NN1001X, 111NP0017X, 111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty