Provider Demographics
NPI:1588863153
Name:LIFE ALIGN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LIFE ALIGN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHERNIAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-456-6772
Mailing Address - Street 1:8515 EDNA AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4427
Mailing Address - Country:US
Mailing Address - Phone:702-456-6772
Mailing Address - Fax:702-240-0309
Practice Address - Street 1:8515 EDNA AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4427
Practice Address - Country:US
Practice Address - Phone:702-456-6772
Practice Address - Fax:702-240-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB02001OtherMEDICAL LICENSE NUMBER
NVV06588Medicare PIN