Provider Demographics
NPI:1982988382
Name:ONE LIFE CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:ONE LIFE CHIROPRACTIC, PA
Other - Org Name:ONE LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-693-5858
Mailing Address - Street 1:110 SW 96TH LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-7569
Mailing Address - Country:US
Mailing Address - Phone:352-304-8546
Mailing Address - Fax:
Practice Address - Street 1:11203 SE 53RD CT
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-2502
Practice Address - Country:US
Practice Address - Phone:352-693-5858
Practice Address - Fax:352-693-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty