Provider Demographics
NPI:1790120772
Name:LIFETIME CHIROPRACTIC & WELLNESS, INC.
Entity Type:Organization
Organization Name:LIFETIME CHIROPRACTIC & WELLNESS, INC.
Other - Org Name:LIVE WELL CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:713-681-5483
Mailing Address - Street 1:7951 KATY FWY STE S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1947
Mailing Address - Country:US
Mailing Address - Phone:713-681-5483
Mailing Address - Fax:
Practice Address - Street 1:7951 KATY FWY STE S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1947
Practice Address - Country:US
Practice Address - Phone:713-681-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty