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General NPI Number Information
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NPI Number | 1437587987
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE CENTER INC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 4229 BARDSTOWN RD STE 320
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City | LOUISVILLE
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State | KY
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Zip | 40218-3281
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Country | US
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Telephone | 502-491-8073
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Fax | 502-491-8773
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Provider Business Mailing Address
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Address Line | 4229 BARDSTOWN RD STE 320
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City | LOUISVILLE
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State | KY
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Zip | 40218-3281
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Country | US
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Telephone | 502-491-8073
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Fax | 502-491-8773
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS E CLAUSE
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Credential | D.C
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Telephone | 502-491-8073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 39868
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License Number State | KY
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