Provider Demographics
NPI:1306312939
Name:GOOD LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GOOD LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-277-9473
Mailing Address - Street 1:641 SE MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-9682
Mailing Address - Country:US
Mailing Address - Phone:503-277-9473
Mailing Address - Fax:
Practice Address - Street 1:1800 NW 169TH PL STE A310
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7527
Practice Address - Country:US
Practice Address - Phone:503-277-9473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty