Provider Demographics
NPI:1619703568
Name:EXTRAORDINARY LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:EXTRAORDINARY LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-993-5398
Mailing Address - Street 1:9910 MELBA LN
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9418
Mailing Address - Country:US
Mailing Address - Phone:270-993-5398
Mailing Address - Fax:
Practice Address - Street 1:303 E 14TH ST STE 3
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3056
Practice Address - Country:US
Practice Address - Phone:270-297-0028
Practice Address - Fax:270-297-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty