Provider Demographics
NPI:1316146079
Name:NEW LIFE CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:NEW LIFE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-471-5433
Mailing Address - Street 1:2051 REED RD.
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7311
Mailing Address - Country:US
Mailing Address - Phone:260-471-5433
Mailing Address - Fax:260-471-5413
Practice Address - Street 1:2051 REED RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7311
Practice Address - Country:US
Practice Address - Phone:260-471-5433
Practice Address - Fax:260-471-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001976A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty