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General NPI Number Information
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NPI Number | 1689831109
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Entity Type | Organization
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Legal Business Name | LIFE FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 9757 FAIRWAY DR.
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City | POWELL
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State | OH
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Zip | 43065
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Country | US
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Telephone | 614-760-5433
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Fax | 614-760-5434
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Provider Business Mailing Address
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Address Line | 9757 FAIRWAY DR.
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City | POWELL
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State | OH
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Zip | 43065
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Country | US
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Telephone | 614-760-5433
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Fax | 614-760-5434
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RICHARD M SHEPHERD
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Credential | DC
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Telephone | 614-760-5433
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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 | 2982
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License Number State | OH
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