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General NPI Number Information
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NPI Number | 1871892836
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Entity Type | Organization
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Legal Business Name | LIFE IN MOTION CHIROPRACTIC AND WELLNESS
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 205 MAIN ST
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City | RIDGWAY
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State | PA
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Zip | 15853-1015
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Country | US
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Telephone | 814-772-6903
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Fax | 585-672-6179
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Provider Business Mailing Address
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Address Line | 205 MAIN ST
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City | RIDGWAY
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State | PA
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Zip | 15853-1015
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Country | US
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Telephone | 814-772-6903
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Fax | 585-672-6179
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEAN PAUL KONRAD
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Credential | DC
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Telephone | 814-772-6903
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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 | X0118007
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC010897
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License Number State | PA
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