Provider Demographics
NPI:1902090038
Name:LIFE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-362-7717
Mailing Address - Street 1:196 M 55
Mailing Address - Street 2:LIFE FAMILY CHIROPRACTIC
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763
Mailing Address - Country:US
Mailing Address - Phone:989-362-7717
Mailing Address - Fax:
Practice Address - Street 1:196 M 55
Practice Address - Street 2:LIFE FAMILY CHIROPRACTIC
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763
Practice Address - Country:US
Practice Address - Phone:989-362-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty