Provider Demographics
NPI:1639488927
Name:LIFESTYLE HEARING CENTER LLC
Entity Type:Organization
Organization Name:LIFESTYLE HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEL
Authorized Official - Suffix:
Authorized Official - Credentials:HID
Authorized Official - Phone:651-788-9008
Mailing Address - Street 1:3410 FEDERAL DR
Mailing Address - Street 2:SUITE101
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1320
Mailing Address - Country:US
Mailing Address - Phone:651-788-9008
Mailing Address - Fax:651-340-5728
Practice Address - Street 1:3410 FEDERAL DR
Practice Address - Street 2:SUITE101
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1320
Practice Address - Country:US
Practice Address - Phone:651-788-9008
Practice Address - Fax:651-340-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2653237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty