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General NPI Number Information
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NPI Number | 1316146079
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Entity Type | Organization
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Legal Business Name | NEW LIFE CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2051 REED RD
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City | FORT WAYNE
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State | IN
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Zip | 46815-7311
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Country | US
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Telephone | 260-471-5433
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Fax | 260-471-5413
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Provider Business Mailing Address
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Address Line | 2051 REED RD.
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City | FORT WAYNE
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State | IN
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Zip | 46815-7311
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Country | US
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Telephone | 260-471-5433
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Fax | 260-471-5413
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL DAVID FEEMAN
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Credential | D.C.
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Telephone | 260-471-5433
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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 | 08001976A
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License Number State | IN
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