Provider Demographics
NPI:1336337237
Name:LIFE CHIROPRACTIC AND FAMILY WELLNESS PLLC
Entity Type:Organization
Organization Name:LIFE CHIROPRACTIC AND FAMILY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-463-5433
Mailing Address - Street 1:1430 W CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4228
Mailing Address - Country:US
Mailing Address - Phone:903-463-5433
Mailing Address - Fax:903-463-5434
Practice Address - Street 1:1430 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4228
Practice Address - Country:US
Practice Address - Phone:903-463-5433
Practice Address - Fax:903-463-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty