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General NPI Number Information
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NPI Number | 1104019397
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Entity Type | Organization
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Legal Business Name | LORD AND LIFE CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 16494 ST CLAIR AVE SUITE C
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920
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Country | US
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Telephone | 330-386-6222
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Fax | 330-386-3378
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Provider Business Mailing Address
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Address Line | 16494 ST CLAIR AVE SUITE C
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920
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Country | US
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Telephone | 330-386-6222
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Fax | 330-386-3378
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Authorized Official
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Title or Position | PRES/OWNER
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Name | SCOTT RICCIARDI
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Credential | DC
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Telephone | 330-386-6222
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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 | DC 1929
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License Number State | OH
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