Provider Demographics
NPI:1679889752
Name:LIFETIME CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LIFETIME CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-330-7112
Mailing Address - Street 1:911 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4025
Mailing Address - Country:US
Mailing Address - Phone:814-946-4000
Mailing Address - Fax:814-946-4777
Practice Address - Street 1:911 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4025
Practice Address - Country:US
Practice Address - Phone:814-946-4000
Practice Address - Fax:814-946-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty