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General NPI Number Information
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NPI Number | 1700984796
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Entity Type | Organization
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Legal Business Name | LIFETIME CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 630 W INTERSTATE 30 STE 600
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City | GARLAND
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State | TX
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Zip | 75043-5731
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Country | US
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Telephone | 972-203-5800
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Fax | 972-203-5814
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Provider Business Mailing Address
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Address Line | 630 W INTERSTATE 30 STE 600
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City | GARLAND
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State | TX
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Zip | 75043-5731
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Country | US
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Telephone | 972-203-5800
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Fax | 972-203-5814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARLA DAVIS
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Credential | D.C.
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Telephone | 972-203-5800
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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 | 10312
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License Number State | TX
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