Healthcare Provider Details

I. General information

NPI: 1255735387
Provider Name (Legal Business Name): EMPOWERED LIFE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 TOWNE PARK DR STE 400
RINCON GA
31326-9364
US

IV. Provider business mailing address

PO BOX 1459
RINCON GA
31326-1459
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-3482
  • Fax:
Mailing address:
  • Phone: 912-826-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009190
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR009190
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR009190
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIR009190
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR009190
License Number StateGA

VIII. Authorized Official

Name: DR. WENDY NICOLE SANCHES
Title or Position: CEO
Credential: D.C., CACCP
Phone: 912-826-3482