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General NPI Number Information
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NPI Number | 1639527153
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Entity Type | Organization
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Legal Business Name | LEGENDARY LIFE, LTD
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 2603 W 22ND ST SUITE 17
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City | OAK BROOK
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State | IL
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Zip | 60523-1213
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Country | US
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Telephone | 520-431-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 W 22ND ST SUITE 17
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City | OAK BROOK
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State | IL
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Zip | 60523-1213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH TORRENS
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Credential | DC
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Telephone | 520-431-4142
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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 | 038006888
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License Number State | IL
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