Provider Demographics
NPI:1215693767
Name:LIFE QUALITY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:LIFE QUALITY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNFIER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEISKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-327-5086
Mailing Address - Street 1:1707 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4309
Mailing Address - Country:US
Mailing Address - Phone:505-327-5086
Mailing Address - Fax:
Practice Address - Street 1:1707 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4309
Practice Address - Country:US
Practice Address - Phone:505-327-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty