Provider Demographics
NPI:1124330154
Name:CHIROPRACTIC LIFE, L.L.C.
Entity type:Organization
Organization Name:CHIROPRACTIC LIFE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:EUGENA
Authorized Official - Last Name:BACKARIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-822-8456
Mailing Address - Street 1:5150 N 16TH ST
Mailing Address - Street 2:SUITE C-162
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3925
Mailing Address - Country:US
Mailing Address - Phone:480-822-8456
Mailing Address - Fax:866-727-9116
Practice Address - Street 1:5150 N 16TH ST
Practice Address - Street 2:SUITE C-162
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3925
Practice Address - Country:US
Practice Address - Phone:480-822-8456
Practice Address - Fax:866-727-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty