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General NPI Number Information
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NPI Number | 1447848288
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Entity Type | Organization
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Legal Business Name | LIFE DESIGN CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 222 E MAIN ST # 1-C
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City | ENNIS
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State | MT
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Zip | 59729-9229
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Country | US
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Telephone | 406-946-1813
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E MAIN ST # 1-C
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City | ENNIS
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State | MT
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Zip | 59729-9229
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Country | US
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Telephone | 406-946-1813
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | JENNIFER VINE
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Credential | DC
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Telephone | 406-946-1813
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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 |
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License Number State |
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