1134134679 NPI number — LIFETIME CHIROPRACTIC PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134134679 NPI number — LIFETIME CHIROPRACTIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETIME CHIROPRACTIC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134134679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19905 HIGHWAY 7
Provider Second Line Business Mailing Address:
STE A2 LIFETIME CHIROPRACTIC PA
Provider Business Mailing Address City Name:
SHOREWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-470-9962
Provider Business Mailing Address Fax Number:
952-470-1987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19905 HIGHWAY 7
Provider Second Line Business Practice Location Address:
STE A2 LIFETIME CHIROPRACTIC PA
Provider Business Practice Location Address City Name:
SHOREWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-470-9962
Provider Business Practice Location Address Fax Number:
952-470-1987
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASLOSKI
Authorized Official First Name:
MATHEW
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
952-470-9962

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3638 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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