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General NPI Number Information
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NPI Number | 1073773388
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC LIFE CENTER
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 400 BARTON BLVD SUITE 201
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City | ROCKLEDGE
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State | FL
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Zip | 32955-2706
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Country | US
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Telephone | 321-633-1400
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Fax | 321-637-7057
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Provider Business Mailing Address
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Address Line | 400 BARTON BLVD SUITE 201
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City | ROCKLEDGE
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State | FL
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Zip | 32955-2706
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Country | US
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Telephone | 321-633-1400
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Fax | 321-637-7057
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL CLAY BISHOP
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Credential | B.S.,D.C.
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Telephone | 321-633-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH7721
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License Number State | FL
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