Provider Demographics
NPI:1407973803
Name:CHIROPRACTIC & HOLISTIC LIFESTYLES, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC & HOLISTIC LIFESTYLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALDAPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-496-8555
Mailing Address - Street 1:10620 CORPORATE DR STE D
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1711
Mailing Address - Country:US
Mailing Address - Phone:260-496-8555
Mailing Address - Fax:260-496-8488
Practice Address - Street 1:10620 CORPORATE DR STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1711
Practice Address - Country:US
Practice Address - Phone:260-496-8555
Practice Address - Fax:260-496-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001147A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000246820OtherANTHEM BC BS
IN000000246820OtherANTHEM BC BS
INU69051Medicare UPIN