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General NPI Number Information
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NPI Number | 1114529682
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Entity Type | Organization
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Legal Business Name | CONNECTED LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 2616 COVELL VILLAGE DR STE 120
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City | EDMOND
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State | OK
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Zip | 73003-9703
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Country | US
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Telephone | 405-920-6440
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Fax | 405-920-6446
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Provider Business Mailing Address
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Address Line | 2616 COVELL VILLAGE DR STE 120
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City | EDMOND
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State | OK
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Zip | 73003-9703
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Country | US
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Telephone | 405-920-6440
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Fax | 405-920-6446
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA URRUTIA
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Credential | DC
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Telephone | 406-920-6440
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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 |
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License Number State |
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