Provider Demographics
NPI:1356709141
Name:LIFEFORCE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:LIFEFORCE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LIUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-790-3000
Mailing Address - Street 1:516 HAMBURG TPKE
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2062
Mailing Address - Country:US
Mailing Address - Phone:973-790-3000
Mailing Address - Fax:973-790-3001
Practice Address - Street 1:516 HAMBURG TPKE
Practice Address - Street 2:SUITE # 5
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2062
Practice Address - Country:US
Practice Address - Phone:973-790-3000
Practice Address - Fax:973-790-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00364300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty