Provider Demographics
NPI:1164515813
Name:LIFETIME WELLNESS FOR YOU INC
Entity Type:Organization
Organization Name:LIFETIME WELLNESS FOR YOU INC
Other - Org Name:THE GREATER WELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LAROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-381-3237
Mailing Address - Street 1:701 MUNRO AVE
Mailing Address - Street 2:P O BOX 436
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3424
Mailing Address - Country:US
Mailing Address - Phone:914-381-3237
Mailing Address - Fax:914-381-3238
Practice Address - Street 1:701 MUNRO AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3424
Practice Address - Country:US
Practice Address - Phone:914-381-3237
Practice Address - Fax:914-381-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty