Provider Demographics
NPI:1457621526
Name:HEALTHY LIFE CHIROPRACTIC AND WELLNESS, LLC
Entity type:Organization
Organization Name:HEALTHY LIFE CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-474-2273
Mailing Address - Street 1:1601 BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4815
Mailing Address - Country:US
Mailing Address - Phone:636-474-2273
Mailing Address - Fax:636-474-2272
Practice Address - Street 1:1601 BRYAN RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4815
Practice Address - Country:US
Practice Address - Phone:636-474-2273
Practice Address - Fax:636-474-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002024752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3515OtherPTAN
MA3515OtherPTAN