Provider Demographics
NPI:1063832772
Name:IDEAL LIFESTYLE PRACTICE LLC
Entity Type:Organization
Organization Name:IDEAL LIFESTYLE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:843-424-5847
Mailing Address - Street 1:757 LONG POINT RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8328
Mailing Address - Country:US
Mailing Address - Phone:843-424-5847
Mailing Address - Fax:
Practice Address - Street 1:757 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8328
Practice Address - Country:US
Practice Address - Phone:843-424-5847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3867111N00000X
SC3868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3867OtherSOUTH CAROLINA STATE LICENSE NUMBER