Organization
AUTHENTIC LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGIA J NAB DC (OWNER/CHIEF CLINICAL OFFICER)
(913) 562-4621
Entity
Organization
Contact information
Practice address
11960 WEST 119TH STREET, OVERLAND PARK, KS 66213
(913) 563-4621
Mailing address
11960 WEST 119TH STREET, OVERLAND PARK, KS 66213
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
04604
KS
111NN1001X
Nutrition Chiropractor
04640
KS
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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