Provider Demographics
NPI:1609040799
Name:LIFE WELLNESS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LIFE WELLNESS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIBELLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-766-7300
Mailing Address - Street 1:821 E BROADWAY AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-5934
Mailing Address - Country:US
Mailing Address - Phone:509-766-7300
Mailing Address - Fax:509-766-7400
Practice Address - Street 1:821 E BROADWAY AVE STE 18
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-5934
Practice Address - Country:US
Practice Address - Phone:509-766-7300
Practice Address - Fax:509-766-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV07347Medicare UPIN
WA8857213Medicare PIN