MEDICARE: TRUE LIFE 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

General Provider Information

NPI Number	:	1912740036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE LIFE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	425 E 61ST ST N STE 1A
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1960
Country	:	US
Telephone Number	:	316-369-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E 61ST ST N STE 1A
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1960
Country	:	US
Telephone Number	:	316-369-0037
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	JORDAN LEIGH GARDINIER
Credential	:	DC
Telephone Number	:	316-369-0037

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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