Provider Demographics
NPI:1093977241
Name:HEALTHY LIFESTYLE WELLNESS CENTER INC
Entity Type:Organization
Organization Name:HEALTHY LIFESTYLE WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, DC , BS MS
Authorized Official - Phone:620-241-9669
Mailing Address - Street 1:400 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-3315
Mailing Address - Country:US
Mailing Address - Phone:620-241-9669
Mailing Address - Fax:620-504-6204
Practice Address - Street 1:400 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-3315
Practice Address - Country:US
Practice Address - Phone:620-241-9669
Practice Address - Fax:620-504-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty