Provider Demographics
NPI:1548322589
Name:LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-764-7575
Mailing Address - Street 1:13849 S MUR LEN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1652
Mailing Address - Country:US
Mailing Address - Phone:913-764-7575
Mailing Address - Fax:913-764-5643
Practice Address - Street 1:13849 S MUR LEN RD
Practice Address - Street 2:SUITE E
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1652
Practice Address - Country:US
Practice Address - Phone:913-764-7575
Practice Address - Fax:913-764-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI240000Medicare ID - Type Unspecified