Provider Demographics
NPI:1417349051
Name:LIFESTYLE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:LIFESTYLE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-861-6744
Mailing Address - Street 1:65 E 1ST AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-1456
Mailing Address - Country:US
Mailing Address - Phone:480-962-4649
Mailing Address - Fax:480-962-8617
Practice Address - Street 1:65 E 1ST AVE
Practice Address - Street 2:STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1456
Practice Address - Country:US
Practice Address - Phone:480-962-4649
Practice Address - Fax:480-962-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8452261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service