Organization
LIFE CLINIC OF NJ DC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REZA POUR ALIZADEH DC (OWNER/DC)
(612) 868-6894
Entity
Organization
Contact information
Practice address
7 FORRESTAL ROAD S, PLAINSBOROUGH, NJ 08536
(612) 868-6894
Mailing address
PO BOX 549, CHANHASSEN, MN 55317-0549
(612) 868-6894
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
38MC00735800
NJ
Other
Enumeration date
04/20/2018
Last updated
04/20/2018
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