Provider Demographics
NPI:1134247505
Name:LIFETIME CHIROPRACTIC
Entity type:Organization
Organization Name:LIFETIME CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:TATSUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-397-1909
Mailing Address - Street 1:1002 WIBLE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-4137
Mailing Address - Country:US
Mailing Address - Phone:661-397-1909
Mailing Address - Fax:661-397-1954
Practice Address - Street 1:1002 WIBLE RD
Practice Address - Street 2:SUITE H
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4137
Practice Address - Country:US
Practice Address - Phone:661-397-1909
Practice Address - Fax:661-397-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty