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General NPI Number Information
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NPI Number | 1467714964
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Entity Type | Organization
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Legal Business Name | LIFE AGAIN CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 365 RENTON CENTER WAY SW STE. F
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City | RENTON
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State | WA
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Zip | 98057-2324
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Country | US
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Telephone | 425-226-7061
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Fax |
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Provider Business Mailing Address
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Address Line | 365 RENTON CENTER WAY SW STE. F
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City | RENTON
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State | WA
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Zip | 98057-2324
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Country | US
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Telephone | 425-226-7061
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID NATHAN MERRILL I
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Credential | DC
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Telephone | 206-724-1843
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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 | 2544
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License Number State | WA
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