Provider Demographics
NPI:1417135062
Name:LIFESTYLE WELLNESS CENTER PC
Entity Type:Organization
Organization Name:LIFESTYLE WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WEINZETL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-728-3371
Mailing Address - Street 1:4140 LEGACY DR
Mailing Address - Street 2:324
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3495
Mailing Address - Country:US
Mailing Address - Phone:469-241-9665
Mailing Address - Fax:469-241-9224
Practice Address - Street 1:4140 LEGACY DR
Practice Address - Street 2:324
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3495
Practice Address - Country:US
Practice Address - Phone:469-241-9665
Practice Address - Fax:469-241-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty