Provider Demographics
NPI:1285964981
Name:MBE2 ALIGN LIFE
Entity type:Organization
Organization Name:MBE2 ALIGN LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRETTNEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RAMSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-421-8020
Mailing Address - Street 1:600 MAIN ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2051
Mailing Address - Country:US
Mailing Address - Phone:570-421-8020
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2051
Practice Address - Country:US
Practice Address - Phone:570-421-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADC005908L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty