Provider Demographics
NPI:1477136778
Name:LIFESOURCE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:LIFESOURCE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:VIERHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-961-5110
Mailing Address - Street 1:4483 WEYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8601
Mailing Address - Country:US
Mailing Address - Phone:330-764-3434
Mailing Address - Fax:330-725-8746
Practice Address - Street 1:4483 WEYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8601
Practice Address - Country:US
Practice Address - Phone:330-764-3434
Practice Address - Fax:330-725-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty