MEDICARE: LIFE ALIGN CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B02001	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B02001	OTHER	NV	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1588863153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ALIGN CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	8515 EDNA AVE
Second Line	:	SUITE 240
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4427
Country	:	US
Telephone Number	:	702-456-6772
Fax Number	:	702-240-0309

Provider Business Practice Location Address
First Line	:	8515 EDNA AVE
Second Line	:	SUITE 240
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4427
Country	:	US
Telephone Number	:	702-456-6772
Fax Number	:	702-240-0309

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANGELA N CHERNIAWSKI
Credential	:	DC
Telephone Number	:	702-456-6772

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	08/22/2008

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