MEDICARE: LIFETIME CHIROPRACTIC CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		WI

General Provider Information

NPI Number	:	1952671034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 666
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53008-0666
Country	:	US
Telephone Number	:	414-643-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W CLEVELAND AVE STE 100
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	262-389-8622
Fax Number	:	414-643-6400

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. MICHAEL JANUSZ
Credential	:
Telephone Number	:	414-643-6000

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	05/05/2018

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