Healthcare Provider Details

I. General information

NPI: 1235571779
Provider Name (Legal Business Name): NEW LIFE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 AMES ST
BALDWIN CITY KS
66006-3099
US

IV. Provider business mailing address

PO BOX 83
BALDWIN CITY KS
66006-0083
US

V. Phone/Fax

Practice location:
  • Phone: 785-594-4894
  • Fax:
Mailing address:
  • Phone: 402-245-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05545
License Number StateKS

VIII. Authorized Official

Name: DR. CALEB DOUGLAS RAMSEY
Title or Position: MEMBER
Credential: D.C.
Phone: 402-245-7550