Healthcare Provider Details

I. General information

NPI: 1558613877
Provider Name (Legal Business Name): LIFESTYLE CHIROPRACTIC AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 WALNUT ST
KANSAS CITY MO
64108-1315
US

IV. Provider business mailing address

1735 WALNUT ST
KANSAS CITY MO
64108-1315
US

V. Phone/Fax

Practice location:
  • Phone: 816-216-8778
  • Fax: 816-817-3280
Mailing address:
  • Phone: 816-216-8778
  • Fax: 816-817-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2012012018
License Number StateMO

VIII. Authorized Official

Name: DR. SHELLEY LOWMAN
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 816-216-8778