Provider Demographics
NPI:1760883052
Name:LIFETIME WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:LIFETIME WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:FABALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-321-6697
Mailing Address - Street 1:333 S BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4314
Mailing Address - Country:US
Mailing Address - Phone:714-594-3318
Mailing Address - Fax:888-899-5949
Practice Address - Street 1:333 S BEVERLY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4314
Practice Address - Country:US
Practice Address - Phone:714-594-3318
Practice Address - Fax:888-899-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC698547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty