Healthcare Provider Details

I. General information

NPI: 1235610213
Provider Name (Legal Business Name): NATURAL LIFE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90971 S WILLAMETTE ST
COBURG OR
97408-9206
US

IV. Provider business mailing address

PO BOX 81
SPRINGFIELD OR
97477-0005
US

V. Phone/Fax

Practice location:
  • Phone: 931-224-3893
  • Fax: 541-747-1535
Mailing address:
  • Phone: 833-628-5433
  • Fax: 833-628-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5838
License Number StateOR

VIII. Authorized Official

Name: NICOLE MARIE WESTBROOK
Title or Position: OWNER
Credential:
Phone: 833-628-5433