Provider Demographics
NPI:1770103525
Name:HEALTHY LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:HEALTHY LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-222-6264
Mailing Address - Street 1:4124 CADENA RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4625
Mailing Address - Country:US
Mailing Address - Phone:940-222-6264
Mailing Address - Fax:
Practice Address - Street 1:4401 N I 35 UNIT 103
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3433
Practice Address - Country:US
Practice Address - Phone:940-222-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty