Provider Demographics
NPI:1548045727
Name:CHIROLIFE WELLNESS
Entity type:Organization
Organization Name:CHIROLIFE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-721-5824
Mailing Address - Street 1:240 SEA GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-4831
Mailing Address - Country:US
Mailing Address - Phone:479-721-5824
Mailing Address - Fax:
Practice Address - Street 1:310 THIRD ST STE B
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1834
Practice Address - Country:US
Practice Address - Phone:850-673-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty