Healthcare Provider Details

I. General information

NPI: 1679485197
Provider Name (Legal Business Name): MEDICAL PHARMA LIFE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PHYSICIANS WAY STE 270
LEBANON TN
37090-8102
US

IV. Provider business mailing address

100 PHYSICIANS WAY STE 270
LEBANON TN
37090-8102
US

V. Phone/Fax

Practice location:
  • Phone: 855-831-2002
  • Fax: 855-831-2002
Mailing address:
  • Phone: 855-831-2002
  • Fax: 855-831-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN POWELL
Title or Position: DIRECTOR
Credential: MD
Phone: 855-855-8312