Provider Demographics
NPI:1457690638
Name:UC4LIFE WELLNESS CENTER
Entity Type:Organization
Organization Name:UC4LIFE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:LISERIO
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-468-1891
Mailing Address - Street 1:3707 N SAINT MARYS ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3168
Mailing Address - Country:US
Mailing Address - Phone:210-468-1891
Mailing Address - Fax:210-591-7827
Practice Address - Street 1:3707 N SAINT MARYS ST
Practice Address - Street 2:STE. 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3168
Practice Address - Country:US
Practice Address - Phone:210-468-1891
Practice Address - Fax:210-591-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11313111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty