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General NPI Number Information
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NPI Number | 1225727704
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Entity Type | Organization
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Legal Business Name | LIFE CLINIC OF IA PC
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 11911 HICKMAN RD
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City | URBANDALE
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State | IA
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Zip | 50323-1814
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Country | US
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Telephone | 612-868-6894
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | CHANHASSEN
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State | MN
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Zip | 55317-0549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REZA ALIZADEH
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Credential | DC
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Telephone | 612-868-6894
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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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