Organization
LIFE CHIROPRACTIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN PANTLEO D.C. (OWNER)
(417) 724-2225
Entity
Organization
Contact information
Practice address
611 W MOUNT VERNON ST STE C, NIXA, MO 65714-9601
(417) 724-2225
Mailing address
611 W MOUNT VERNON ST STE C, NIXA, MO 65714-9601
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2015030812
MO
Other
Enumeration date
08/26/2015
Last updated
09/24/2015
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