Organization
PURE LIFE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN VIGNEAU DC (SOLE MBR)
(480) 290-9899
Entity
Organization
Contact information
Practice address
4725 STATESMEN DR STE B, INDIANAPOLIS, IN 46250-5645
(480) 566-9755
Mailing address
4725 STATESMEN DR STE B, INDIANAPOLIS, IN 46250-5645
(480) 566-9755
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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