Provider Demographics
NPI:1689112245
Name:LIFELINE CHIROPRACTIC AND NATURAL MEDICINE PC
Entity Type:Organization
Organization Name:LIFELINE CHIROPRACTIC AND NATURAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUFFALINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-626-5088
Mailing Address - Street 1:1133 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1133 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3684
Practice Address - Country:US
Practice Address - Phone:910-679-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCT5000281OtherMEDICARE PTAN