Provider Demographics
NPI:1134599111
Name:FIT FOR LIFE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:FIT FOR LIFE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-333-7600
Mailing Address - Street 1:320 POST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2257
Mailing Address - Country:US
Mailing Address - Phone:516-333-7600
Mailing Address - Fax:516-333-7601
Practice Address - Street 1:320 POST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2257
Practice Address - Country:US
Practice Address - Phone:516-333-7600
Practice Address - Fax:516-333-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty