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General NPI Number Information
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NPI Number | 1417135062
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Entity Type | Organization
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Legal Business Name | LIFESTYLE WELLNESS CENTER PC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 4140 LEGACY DR 324
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City | PLANO
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State | TX
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Zip | 75024-3495
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Country | US
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Telephone | 469-241-9665
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Fax | 469-241-9224
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Provider Business Mailing Address
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Address Line | 4140 LEGACY DR 324
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City | PLANO
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State | TX
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Zip | 75024-3495
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Country | US
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Telephone | 469-241-9665
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Fax | 469-241-9224
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAD EDWARD WEINZETL
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Credential | D.C.
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Telephone | 214-728-3371
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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 | 10816
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License Number State | TX
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