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General NPI Number Information
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NPI Number | 1003049008
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Entity Type | Organization
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Legal Business Name | LIFETIME CHIROPRACTIC PC
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 120 PROSPECTER DR
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City | VILLA RICA
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State | GA
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Zip | 30180-5331
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Country | US
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Telephone | 770-459-5070
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Fax | 770-459-1070
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Provider Business Mailing Address
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Address Line | 120 PROSPECTER DR
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City | VILLA RICA
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State | GA
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Zip | 30180-5331
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Country | US
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Telephone | 770-459-5070
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Fax | 770-459-1070
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Authorized Official
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Title or Position | OWNER
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Name | DR. JODY A MATTHEWS
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Credential | DC,BA
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Telephone | 770-459-5070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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