Provider Demographics
NPI:1790956274
Name:LIFESTYLE CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:LIFESTYLE CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-677-1616
Mailing Address - Street 1:54820 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1705
Mailing Address - Country:US
Mailing Address - Phone:568-677-1616
Mailing Address - Fax:
Practice Address - Street 1:54820 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1705
Practice Address - Country:US
Practice Address - Phone:568-677-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N97150Medicare PIN