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General NPI Number Information
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NPI Number | 1235610213
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Entity Type | Organization
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Legal Business Name | NATURAL LIFE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 90971 S WILLAMETTE ST
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City | COBURG
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State | OR
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Zip | 97408-9206
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Country | US
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Telephone | 931-224-3893
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Fax | 541-747-1535
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Provider Business Mailing Address
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Address Line | PO BOX 81
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City | SPRINGFIELD
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State | OR
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Zip | 97477-0005
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Country | US
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Telephone | 833-628-5433
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Fax | 833-628-5433
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE MARIE WESTBROOK
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Credential |
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Telephone | 833-628-5433
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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 | 5838
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License Number State | OR
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