Organization
CHIROPRACTIC LIFE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CLAY BISHOP B.S.,D.C. (OWNER)
(321) 633-1400
Entity
Organization
Contact information
Practice address
400 BARTON BLVD, SUITE 201, ROCKLEDGE, FL 32955-2706
(321) 633-1400
(321) 637-7057
Mailing address
400 BARTON BLVD, SUITE 201, ROCKLEDGE, FL 32955-2706
(321) 633-1400
(321) 637-7057
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH7721
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55880
—
FL
01
—
5954350001
PTAN
—
Enumeration date
06/10/2008
Last updated
06/10/2008
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