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General NPI Number Information
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NPI Number | 1154553725
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Entity Type | Organization
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Legal Business Name | LIFETIME WELLNESS LLC
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 08/17/2009
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Provider Practice Location Address
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Address Line | 3901 ROSWELL RD SUITE 208
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City | MARIETTA
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State | GA
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Zip | 30062-8809
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Country | US
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Telephone | 770-509-9717
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Fax | 770-509-8796
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Provider Business Mailing Address
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Address Line | 3901 ROSWELL RD SUITE 208
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City | MARIETTA
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State | GA
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Zip | 30062-8809
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Country | US
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Telephone | 770-509-9717
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Fax | 770-509-8796
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Authorized Official
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Title or Position | CHIROPRACTOR, OPERATOR
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Name | DR. AMANDA S FRIEDHOFF
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Credential | B.S., D.C.
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Telephone | 770-509-9717
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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 | CHIR008386
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License Number State | GA
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