Provider Demographics
NPI:1336977248
Name:GREATER LIFE FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GREATER LIFE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-679-4238
Mailing Address - Street 1:653 E 128TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-9652
Mailing Address - Country:US
Mailing Address - Phone:408-679-4238
Mailing Address - Fax:
Practice Address - Street 1:135 W STATE RD
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8172
Practice Address - Country:US
Practice Address - Phone:231-335-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER LIFE FAMILY CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-23
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center