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General NPI Number Information
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NPI Number | 1124487194
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Entity Type | Organization
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Legal Business Name | LIFETIME WELLNESS CHIROPRACTIC OF WESTERN NEW YORK
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 1580 ELMWOOD AVE SUITE 1A
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City | ROCHESTER
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State | NY
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Zip | 14620-3620
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Country | US
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Telephone | 585-471-5919
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 ELMWOOD AVE SUITE 1A
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City | ROCHESTER
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State | NY
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Zip | 14620-3620
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Country | US
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Telephone | 585-471-5919
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. RACHEL MEEGAN-IACCHETTA
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Credential | D.C.
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Telephone | 585-471-5919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 012270
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License Number State | NY
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