Provider Demographics
NPI:1649444571
Name:NEW LIFE CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:NEW LIFE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-574-5678
Mailing Address - Street 1:3451 COBB PKWY NW STE 4
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4000
Mailing Address - Country:US
Mailing Address - Phone:678-574-5678
Mailing Address - Fax:
Practice Address - Street 1:3451 COBB PKWY NW STE 4
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4000
Practice Address - Country:US
Practice Address - Phone:678-574-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty