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General NPI Number Information
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NPI Number | 1144372558
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Entity Type | Organization
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Legal Business Name | THE LIFEFORCE CENTER, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3111 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2402
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Country | US
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Telephone | 847-562-0840
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 W BELMONT AVE SUITE 407
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 773-880-1363
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHAD C. LARSON
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Credential | D.C.
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Telephone | 773-880-1363
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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 | 38007103
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License Number State | IL
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