Provider Demographics
NPI:1669615126
Name:PURE LIFE CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:PURE LIFE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-667-9929
Mailing Address - Street 1:1267 CELEBRATION BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5499
Mailing Address - Country:US
Mailing Address - Phone:843-667-9929
Mailing Address - Fax:843-667-9930
Practice Address - Street 1:1267 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5499
Practice Address - Country:US
Practice Address - Phone:843-667-9929
Practice Address - Fax:843-667-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty