Provider Demographics
NPI:1427327949
Name:CAFE OF LIFE, PLLC
Entity type:Organization
Organization Name:CAFE OF LIFE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-444-7744
Mailing Address - Street 1:2835 PEARL ST STE D
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1141
Mailing Address - Country:US
Mailing Address - Phone:303-444-7744
Mailing Address - Fax:720-226-9078
Practice Address - Street 1:2835 PEARL ST STE D
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1141
Practice Address - Country:US
Practice Address - Phone:303-444-7744
Practice Address - Fax:720-226-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty