Organization
LIFE CLINIC OF GA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REZA ALIZADEH (PRESIDENT)
(612) 868-6894
Entity
Organization
Contact information
Practice address
14200 HIGHWAY 92, WOODSTOCK, GA 30188-7139
(952) 229-7464
Mailing address
PO BOX 549, CHANHASSEN, MN 55317-0549
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
02/09/2022
Last updated
02/09/2022
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