Provider Demographics
NPI:1154892883
Name:LIFEFORGE, PLLC
Entity type:Organization
Organization Name:LIFEFORGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:843-422-8115
Mailing Address - Street 1:408 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3183
Mailing Address - Country:US
Mailing Address - Phone:817-779-3435
Mailing Address - Fax:
Practice Address - Street 1:408 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3183
Practice Address - Country:US
Practice Address - Phone:817-779-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty