Healthcare Provider Details

I. General information

NPI: 1932151909
Provider Name (Legal Business Name): LIFESTYLE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 LEWIS AVE
TEMPERANCE MI
48182-1661
US

IV. Provider business mailing address

8100 LEWIS AVE
TEMPERANCE MI
48182-1661
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-5758
  • Fax: 734-847-2358
Mailing address:
  • Phone: 734-847-5758
  • Fax: 734-847-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008290
License Number StateMI

VIII. Authorized Official

Name: DR. DARYL LEE LAJINESS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 734-847-5758