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General NPI Number Information
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NPI Number | 1679937601
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Entity Type | Organization
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Legal Business Name | LIFECLINIC PHYSICAL THERAPY & CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 1499 YAMATO RD
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City | BOCA RATON
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State | FL
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Zip | 33431-4435
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Country | US
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Telephone | 561-208-5900
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Fax | 952-474-1504
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | CHANHASSEN
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State | MN
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Zip | 55317-0549
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Country | US
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Telephone | 952-229-7558
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Fax | 952-474-1504
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. REZA POUR ALIZADEH
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Credential | DC
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Telephone | 612-868-6894
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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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