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General NPI Number Information
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NPI Number | 1124344338
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Entity Type | Organization
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Legal Business Name | NEW LIFE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 1248 W DANVILLE ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-3504
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Country | US
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Telephone | 434-447-3049
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Fax | 434-447-3049
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Provider Business Mailing Address
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Address Line | 1248 W DANVILLE ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-3504
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Country | US
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Telephone | 434-447-3049
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Fax | 434-447-3049
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | JESSICA ANNE UPTON
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Credential | D.C.
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Telephone | 434-447-3049
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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 | 0104556743
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License Number State | VA
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