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General NPI Number Information
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NPI Number | 1740787449
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Entity Type | Organization
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Legal Business Name | LIFE SOURCE, A PARLETT CORPORATION
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 844 W SAN MARCOS BLVD STE 101
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City | SAN MARCOS
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State | CA
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Zip | 92078-1137
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Country | US
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Telephone | 760-266-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 12153 MIDDLEBROOK SQ
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City | SAN DIEGO
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State | CA
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Zip | 92128-3756
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Country | US
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Telephone | 858-231-0304
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CHASE PARLETT
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Credential | DC
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Telephone | 760-266-7799
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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 | 34148
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License Number State | CA
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