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General NPI Number Information
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NPI Number | 1770099855
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Entity Type | Organization
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Legal Business Name | GOOD LIFE HEALTH CARE
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 304 S MAIN ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2606
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Country | US
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Telephone | 864-962-3116
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S MAIN ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2606
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Country | US
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Telephone | 864-962-3116
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Fax |
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Authorized Official
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Title or Position | DC/OWNER
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Name | LACEY B MOHAR
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Credential | DC
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Telephone | 864-962-3116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | X012196-1
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License Number State | NY
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