Organization
LIFE SOURCE CHIROPRACTIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED GALSTER D.C. (PRESIDENT)
(802) 773-0010
Entity
Organization
Contact information
Practice address
90 MAHONEY AVE, RUTLAND, VT 05701-4836
(802) 773-0010
(802) 773-0010
Mailing address
90 MAHONEY AVE, RUTLAND, VT 05701-4836
(802) 773-0010
(802) 773-0010
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0060072505
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0028156
MEDICARE PTAN
VT
05
—
1022039
—
VT
Enumeration date
05/14/2012
Last updated
08/26/2014
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