Provider Demographics
NPI:1952671034
Name:LIFETIME CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:LIFETIME CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-643-6000
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-0666
Mailing Address - Country:US
Mailing Address - Phone:414-643-6000
Mailing Address - Fax:
Practice Address - Street 1:2727 W CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2956
Practice Address - Country:US
Practice Address - Phone:262-389-8622
Practice Address - Fax:414-643-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty