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General NPI Number Information
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NPI Number | 1386954667
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Entity Type | Organization
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Legal Business Name | NEW LIFE FAMILY CHIROPRACTIC & WELLNESS PLLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 1045 THOMAS JEFFERSON RD SUITE 1D
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City | FOREST
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State | VA
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Zip | 24551-4642
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Country | US
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Telephone | 434-534-9426
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Fax | 434-534-9428
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Provider Business Mailing Address
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Address Line | 1045 THOMAS JEFFERSON RD SUITE 1D
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City | FOREST
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State | VA
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Zip | 24551-4642
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Country | US
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Telephone | 434-534-9426
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Fax | 434-534-9428
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK WILLIAM STULL
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Credential | DC
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Telephone | 434-534-9426
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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 | 0104556832
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License Number State | VA
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