Provider Demographics
NPI:1124351705
Name:TREE OF LIFE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:TREE OF LIFE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:MROZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-482-5990
Mailing Address - Street 1:11 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-1351
Mailing Address - Country:US
Mailing Address - Phone:330-482-5990
Mailing Address - Fax:
Practice Address - Street 1:11 E PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1351
Practice Address - Country:US
Practice Address - Phone:330-482-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMR4178552Medicare PIN
OHV08469Medicare UPIN