Provider Demographics
NPI:1194445486
Name:CHIROLIFE OF OMAHA
Entity type:Organization
Organization Name:CHIROLIFE OF OMAHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMILLIONARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TOWNS DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-464-0111
Mailing Address - Street 1:11530 WESTWOOD LN APT 26
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4361
Mailing Address - Country:US
Mailing Address - Phone:605-464-0111
Mailing Address - Fax:
Practice Address - Street 1:644 N SADDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2500
Practice Address - Country:US
Practice Address - Phone:402-551-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty