Provider Demographics
NPI:1730653353
Name:LIFELONG NUTRITION AND WELLNESS
Entity Type:Organization
Organization Name:LIFELONG NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYLEE
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:MEVORAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-343-0318
Mailing Address - Street 1:2757 LOWER LAKE RD APT B
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-9429
Mailing Address - Country:US
Mailing Address - Phone:732-343-0318
Mailing Address - Fax:
Practice Address - Street 1:216 MONTOUR ST
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865-9669
Practice Address - Country:US
Practice Address - Phone:607-535-6094
Practice Address - Fax:607-535-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922570779OtherNPI