Provider Demographics
NPI:1023178084
Name:LIFE FAMILY CHIROPRACTIC, PA
Entity type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-267-3030
Mailing Address - Street 1:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-1319
Mailing Address - Country:US
Mailing Address - Phone:479-267-3030
Mailing Address - Fax:479-267-5725
Practice Address - Street 1:123 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-3125
Practice Address - Country:US
Practice Address - Phone:479-267-3030
Practice Address - Fax:479-267-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F360OtherBCBS AR
AR5F360Medicare ID - Type UnspecifiedOFFICE