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General NPI Number Information
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NPI Number | 1790349686
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Entity Type | Organization
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Legal Business Name | LIFE ALIVE, LLC
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 01/04/2026
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Provider Practice Location Address
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Address Line | 411 W PONCE DE LEON AVE
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City | DECATUR
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State | GA
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Zip | 30030-2444
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Country | US
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Telephone | 404-883-5289
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 STANWOOD AVE SE
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City | ATLANTA
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State | GA
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Zip | 30317-1911
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Country | US
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Telephone | 706-201-2486
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANET CHENG
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Credential |
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Telephone | 706-201-2486
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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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