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General NPI Number Information
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NPI Number | 1063777522
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Entity Type | Organization
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Legal Business Name | LIFESTYLE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 721 W HICKORY ST
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City | DENTON
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State | TX
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Zip | 76201-4044
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Country | US
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Telephone | 940-387-0405
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Fax | 940-383-2966
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Provider Business Mailing Address
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Address Line | 2317 W UNIVERSITY DR STE B5
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City | DENTON
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State | TX
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Zip | 76201-1699
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Country | US
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Telephone | 940-387-0405
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Fax | 940-383-2966
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Authorized Official
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Title or Position | SOLE MBR
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Name | TODD LEE PORTER
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Credential | D.C.
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Telephone | 940-387-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6387
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License Number State | TX
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