Provider Demographics
NPI:1295274520
Name:PURE LIGHT FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:PURE LIGHT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:458-202-4303
Mailing Address - Street 1:61561 AARON WAY
Mailing Address - Street 2:#6303
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-8804
Mailing Address - Country:US
Mailing Address - Phone:781-820-6816
Mailing Address - Fax:
Practice Address - Street 1:155 SW CENTURY DR
Practice Address - Street 2:BEND PILATES
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1657
Practice Address - Country:US
Practice Address - Phone:781-820-6816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5802261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty