Provider Demographics
NPI:1336743160
Name:LIFE LONG WELLNESS PC
Entity Type:Organization
Organization Name:LIFE LONG WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-593-8112
Mailing Address - Street 1:757 N 100 E
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1252
Mailing Address - Country:US
Mailing Address - Phone:801-540-0437
Mailing Address - Fax:801-593-0768
Practice Address - Street 1:73 E 200 N
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1952
Practice Address - Country:US
Practice Address - Phone:801-593-8112
Practice Address - Fax:801-593-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty