Provider Demographics
NPI:1871892836
Name:LIFE IN MOTION CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:LIFE IN MOTION CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-772-6903
Mailing Address - Street 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1015
Mailing Address - Country:US
Mailing Address - Phone:814-772-6903
Mailing Address - Fax:585-672-6179
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-1015
Practice Address - Country:US
Practice Address - Phone:814-772-6903
Practice Address - Fax:585-672-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0118007111N00000X
PADC010897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty