Provider Demographics
NPI:1427426881
Name:LIFE FORCE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:LIFE FORCE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-760-4141
Mailing Address - Street 1:7704 QUARTERFIELD RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4412
Mailing Address - Country:US
Mailing Address - Phone:410-760-4141
Mailing Address - Fax:410-863-0095
Practice Address - Street 1:7704 QUARTERFIELD RD
Practice Address - Street 2:SUITE H
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4412
Practice Address - Country:US
Practice Address - Phone:410-760-4141
Practice Address - Fax:410-863-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403105900Medicaid
MD903RMedicare PIN