MEDICARE: CHIRO LIFE 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	225100000X	Physical Therapist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1609094770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO LIFE LLC

Provider Business Mailing Address
First Line	:	7257 CENTER ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4907
Country	:	US
Telephone Number	:	440-205-9910
Fax Number	:	440-974-2400

Provider Business Practice Location Address
First Line	:	7257 CENTER ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4907
Country	:	US
Telephone Number	:	440-205-9910
Fax Number	:	440-974-2400

Authorized Official
Title or Position	:	BILLING/CREDENTIALING MANAGER
Name	:	LINDA L GROVES
Credential	:	CPC CPCH
Telephone Number	:	440-352-4321

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	01/27/2015

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Directions to “CHIRO LIFE LLC ” Practice Location

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