Healthcare Provider Details

I. General information

NPI: 1164353462
Provider Name (Legal Business Name): LIFETIME WELLNESS CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W MAPLE RD
CLAWSON MI
48017-1109
US

IV. Provider business mailing address

47 W MAPLE RD
CLAWSON MI
48017-1109
US

V. Phone/Fax

Practice location:
  • Phone: 586-256-3725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY SAGALA
Title or Position: OWNER
Credential:
Phone: 248-843-4553