Provider Demographics
NPI:1114928488
Name:HEALTHY LIFESTYLES CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEALTHY LIFESTYLES CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:515-233-2217
Mailing Address - Street 1:213 N DUFF AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6676
Mailing Address - Country:US
Mailing Address - Phone:515-233-2217
Mailing Address - Fax:515-233-4208
Practice Address - Street 1:213 N DUFF AVE
Practice Address - Street 2:STE 5
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6676
Practice Address - Country:US
Practice Address - Phone:515-233-2217
Practice Address - Fax:515-233-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0224972Medicaid
IAI1110Medicare PIN