Provider Demographics
NPI:1871984450
Name:LIFE EFFECT CENTERS LLC
Entity type:Organization
Organization Name:LIFE EFFECT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:239-970-2484
Mailing Address - Street 1:20550 S LAGRANGE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1756
Mailing Address - Country:US
Mailing Address - Phone:815-534-5286
Mailing Address - Fax:815-534-5386
Practice Address - Street 1:20550 S LAGRANGE RD STE 220
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1756
Practice Address - Country:US
Practice Address - Phone:815-534-5286
Practice Address - Fax:815-534-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty