Provider Demographics
NPI:1629192166
Name:LIFEWORKS ON LAKE NORMAN
Entity Type:Organization
Organization Name:LIFEWORKS ON LAKE NORMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-664-5433
Mailing Address - Street 1:637 WILLIAMSON RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8105
Mailing Address - Country:US
Mailing Address - Phone:704-664-5433
Mailing Address - Fax:704-664-0825
Practice Address - Street 1:637 WILLIAMSON RD UNIT 104
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8105
Practice Address - Country:US
Practice Address - Phone:704-664-5433
Practice Address - Fax:704-664-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3648111N00000X
NC3386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty