Healthcare Provider Details

I. General information

NPI: 1104040179
Provider Name (Legal Business Name): LIFETIME HEALTH & WELLNESS CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MCLEAN BLVD STE A
SOUTH ELGIN IL
60177
US

IV. Provider business mailing address

101 S MCLEAN BLVD STE A
SOUTH ELGIN IL
60177-1830
US

V. Phone/Fax

Practice location:
  • Phone: 847-717-3400
  • Fax: 847-255-7945
Mailing address:
  • Phone: 847-717-3400
  • Fax: 847-255-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY NEIL SCHENING
Title or Position: OWNER
Credential: DC
Phone: 847-717-3400