=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427426881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE FORCE CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2015
-----------------------------------------------------
Last Update Date | 07/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7704 QUARTERFIELD RD SUITE H
-----------------------------------------------------
City | GLEN BURNIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21061-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-760-4141
-----------------------------------------------------
Fax | 410-863-0095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7704 QUARTERFIELD RD SUITE H
-----------------------------------------------------
City | GLEN BURNIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21061-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-760-4141
-----------------------------------------------------
Fax | 410-863-0095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRANDON S HOLLENBERG
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 410-760-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------