1225378417 NPI number — LIFESTYLE CHIROPRACTIC WELLNESS, INC

Table of content: CHRISTIAN ADELL BROWN MMFT (NPI 1851933626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225378417 NPI number — LIFESTYLE CHIROPRACTIC WELLNESS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFESTYLE CHIROPRACTIC WELLNESS, INC
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:
1225378417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSCOE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61073-0888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-623-3379
Provider Business Mailing Address Fax Number:
815-623-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5290 WILLIAMS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSCOE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61073-9222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-623-3379
Provider Business Practice Location Address Fax Number:
815-623-3380
Provider Enumeration Date:
02/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PILLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
OWNER - CHIROPRACTOR
Authorized Official Telephone Number:
815-623-3379

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038-009709 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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