Provider Demographics
NPI:1114529682
Name:CONNECTED LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:CONNECTED LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-920-6440
Mailing Address - Street 1:2616 COVELL VILLAGE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-9703
Mailing Address - Country:US
Mailing Address - Phone:405-920-6440
Mailing Address - Fax:405-920-6446
Practice Address - Street 1:2616 COVELL VILLAGE DR STE 120
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-9703
Practice Address - Country:US
Practice Address - Phone:405-920-6440
Practice Address - Fax:405-920-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty