Provider Demographics
NPI:1902835796
Name:LIFETIME WELLNESS CENTER
Entity Type:Organization
Organization Name:LIFETIME WELLNESS CENTER
Other - Org Name:SPORTS THERAPY USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-430-5203
Mailing Address - Street 1:20928 N JOHN WAYNE PKWY
Mailing Address - Street 2:C-13
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-2922
Mailing Address - Country:US
Mailing Address - Phone:602-430-5203
Mailing Address - Fax:520-568-7832
Practice Address - Street 1:1055 S ARIZONA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-1511
Practice Address - Country:US
Practice Address - Phone:480-917-7246
Practice Address - Fax:480-899-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty