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General NPI Number Information
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NPI Number | 1861504383
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Entity Type | Organization
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Legal Business Name | PRIME LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2504 K AVE SUITE 500
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City | PLANO
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State | TX
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Zip | 75074-5340
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Country | US
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Telephone | 972-424-2225
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Fax | 972-424-7709
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Provider Business Mailing Address
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Address Line | 2504 K AVE SUITE 500
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City | PLANO
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State | TX
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Zip | 75074-5340
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Country | US
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Telephone | 972-424-2225
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Fax | 972-424-7709
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Authorized Official
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Title or Position | OFFICER
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Name | MRS. SHAE ANDERSON
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Credential | OFFICE MANAGER
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Telephone | 972-424-2225
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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 | F006625
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License Number State | TX
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