Provider Demographics
NPI:1962795062
Name:SOUTHEAST LIFEFORCE CORPORATION
Entity type:Organization
Organization Name:SOUTHEAST LIFEFORCE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-514-9590
Mailing Address - Street 1:8549 ANTLERS TRL
Mailing Address - Street 2:
Mailing Address - City:N RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6406
Mailing Address - Country:US
Mailing Address - Phone:216-514-9590
Mailing Address - Fax:216-514-9592
Practice Address - Street 1:23131 EMERY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5136
Practice Address - Country:US
Practice Address - Phone:216-514-9590
Practice Address - Fax:216-514-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty