Provider Demographics
NPI:1134134679
Name:LIFETIME CHIROPRACTIC PA
Entity Type:Organization
Organization Name:LIFETIME CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MASLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-470-9962
Mailing Address - Street 1:19905 HIGHWAY 7
Mailing Address - Street 2:STE A2 LIFETIME CHIROPRACTIC PA
Mailing Address - City:SHOREWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55331
Mailing Address - Country:US
Mailing Address - Phone:952-470-9962
Mailing Address - Fax:952-470-1987
Practice Address - Street 1:19905 HIGHWAY 7
Practice Address - Street 2:STE A2 LIFETIME CHIROPRACTIC PA
Practice Address - City:SHOREWOOD
Practice Address - State:MN
Practice Address - Zip Code:55331
Practice Address - Country:US
Practice Address - Phone:952-470-9962
Practice Address - Fax:952-470-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U76916Medicare UPIN