Provider Demographics
NPI:1609313246
Name:LIFESTYLES HEALTHCARE GROUP PA
Entity Type:Organization
Organization Name:LIFESTYLES HEALTHCARE GROUP PA
Other - Org Name:LIFESTYLES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STOKKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-334-9355
Mailing Address - Street 1:11300 LINDBERGH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8827
Mailing Address - Country:US
Mailing Address - Phone:239-334-9355
Mailing Address - Fax:
Practice Address - Street 1:11300 LINDBERGH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8827
Practice Address - Country:US
Practice Address - Phone:239-334-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty