Provider Demographics
NPI:1043975451
Name:NEW LIFE DISC SPINE & JOINT
Entity type:Organization
Organization Name:NEW LIFE DISC SPINE & JOINT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER (PRESIDENT)
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-502-7897
Mailing Address - Street 1:10384 TINTINHULL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-1574
Mailing Address - Country:US
Mailing Address - Phone:704-502-7897
Mailing Address - Fax:704-327-0793
Practice Address - Street 1:10384 TINTINHULL DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-1574
Practice Address - Country:US
Practice Address - Phone:704-502-7897
Practice Address - Fax:704-327-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty