Life Clinic of NJ DC PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00735800 Issued in NJ

Legal business name

LIFE CLINIC OF NJ DC PA

Practice address

7 Forrestal Road S
Plainsborough, NJ 08536

Phone

(612) 868-6894

NPI assigned

Apr 20, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Reza Pour Alizadeh, DCNPI 1538214598

Title

Owner/DC

Phone

(612) 868-6894

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ian Raphael Barry, DC

  • Chiropractor
  • Short Hills, NJ
  • NPI 1417412966
  Medicare reassignment NPD
• Logan Wrenn Luzadder, DC, ATC

  • Sports Physician Chiropractor
  • Little Egg Harbor TWP, NJ
  • NPI 1356894117
  Medicare reassignment NPD
• Vincent J Martino, D.C.

  • Chiropractor
  • New York, NY
  • NPI 1962538223

  NJ

  Medicare reassignment NPD
• Roger Mitchell, DC

  • Chiropractor
  • Glen Cove, NY
  • NPI 1326562034

  NJ

  Medicare reassignment NPD
• Reza Pour Alizadeh, D.C.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1538214598
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524182400000",
    "number": "1720575178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553170549",
            "telephone_number": "612-868-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 FORRESTAL ROAD S",
            "city": "PLAINSBOROUGH",
            "state": "NJ",
            "postal_code": "08536",
            "telephone_number": "612-868-6894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC OF NJ DC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-20",
        "last_updated": "2018-04-20",
        "status": "A",
        "authorized_official_last_name": "ALIZADEH",
        "authorized_official_first_name": "REZA",
        "authorized_official_middle_name": "POUR",
        "authorized_official_title_or_position": "OWNER/DC",
        "authorized_official_telephone_number": "612-868-6894",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00735800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.