Provider Demographics
NPI:1952624652
Name:LIFE FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-362-7717
Mailing Address - Street 1:196 W M 55
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9251
Mailing Address - Country:US
Mailing Address - Phone:989-362-7717
Mailing Address - Fax:989-362-1491
Practice Address - Street 1:196 W M 55
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9251
Practice Address - Country:US
Practice Address - Phone:989-362-7717
Practice Address - Fax:989-362-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1419581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty