Healthcare Provider Details

I. General information

NPI: 1346723780
Provider Name (Legal Business Name): LIFE CLINIC OF TN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 CAROTHERS PKWY
FRANKLIN TN
37067-6009
US

IV. Provider business mailing address

PO BOX 549
CHANHASSEN MN
55317-0549
US

V. Phone/Fax

Practice location:
  • Phone: 615-685-7058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: REZA ALIZADEH
Title or Position: PRESIDENT
Credential: DC
Phone: 952-229-7464