Provider Demographics
NPI:1275962094
Name:LIFESTYLE CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:LIFESTYLE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ BARALT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-565-7342
Mailing Address - Street 1:PO BOX 367768
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7768
Mailing Address - Country:US
Mailing Address - Phone:787-565-7342
Mailing Address - Fax:
Practice Address - Street 1:89 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6372
Practice Address - Country:US
Practice Address - Phone:787-764-2683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR521261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6145795240Medicare PIN