Provider Demographics
NPI:1992992606
Name:NEW LIFE FAMILY CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:NEW LIFE FAMILY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-769-5433
Mailing Address - Street 1:3610 W 80TH LN
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5061
Mailing Address - Country:US
Mailing Address - Phone:219-769-5433
Mailing Address - Fax:219-769-5433
Practice Address - Street 1:3610 W 80TH LN
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5061
Practice Address - Country:US
Practice Address - Phone:219-769-5433
Practice Address - Fax:219-769-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002092A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000336298OtherBCBS ANTHEM IN
IN90001197OtherBLUE CROSS BLUE SHEILD IL
IN90001197OtherBLUE CROSS BLUE SHEILD IL
IN218110Medicare PIN