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General NPI Number Information
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NPI Number | 1013347046
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Entity Type | Organization
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Legal Business Name | D-LIFE FITNESS, LLC
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 711 VANDIVER DR STE J&K
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City | COLUMBIA
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State | MO
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Zip | 65202-1593
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Country | US
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Telephone | 573-289-7334
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Fax |
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Provider Business Mailing Address
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Address Line | 711 VANDIVER DR STE J&K
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City | COLUMBIA
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State | MO
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Zip | 65202-1593
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Country | US
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Telephone | 573-289-7334
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT / BOOKKEEPER
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Name | SHAMAR ELAINE RICH-HALL
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Credential |
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Telephone | 754-214-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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