| Organization Name: | HEALTH FOR LIFE CLINIC PLLC |
| NPI Number: | 1760736565 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIA PROCTOR (BILLING ADMINISTRATOR) |
| Mailing Address: | 1100 N University Ave Ste 260 Little Rock |
| State: | AR US |
| Postal Code: | 722076343 |
| Phone Number: | 5016030003 |
| Fax Number: | 5016030030 |
| NPI Enumeration Date: | 10/31/2012 |
| NPI Last Update Date: | 10/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C4604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |