Provider Demographics
NPI:1891136610
Name:LIFETIME FAMILY HEALTH CENTER PLLC
Entity Type:Organization
Organization Name:LIFETIME FAMILY HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-310-0301
Mailing Address - Street 1:2637 IRA E WOODS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9013
Mailing Address - Country:US
Mailing Address - Phone:817-310-0301
Mailing Address - Fax:817-423-6701
Practice Address - Street 1:2637 IRA E WOODS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9013
Practice Address - Country:US
Practice Address - Phone:817-310-0301
Practice Address - Fax:817-423-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty