Provider Demographics
NPI:1619464146
Name:LIFESTYLE CHIROPRACTIC AND TRAINING
Entity Type:Organization
Organization Name:LIFESTYLE CHIROPRACTIC AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-766-8765
Mailing Address - Street 1:2418 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2036
Mailing Address - Country:US
Mailing Address - Phone:314-395-6910
Mailing Address - Fax:314-552-7222
Practice Address - Street 1:2418 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2036
Practice Address - Country:US
Practice Address - Phone:314-395-6910
Practice Address - Fax:314-552-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016002467111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty