Healthcare Provider Details

I. General information

NPI: 1053614586
Provider Name (Legal Business Name): PURE LIFE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VALLEY RIVER DR STE 260
EUGENE OR
97401-6760
US

IV. Provider business mailing address

1400 VALLEY RIVER DR STE 260
EUGENE OR
97401-6760
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-5633
  • Fax: 541-762-5633
Mailing address:
  • Phone: 541-343-5633
  • Fax: 541-762-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3808
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER L NYBERG
Title or Position: OWNER
Credential: D.C.
Phone: 541-343-5633