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General NPI Number Information
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NPI Number | 1740017136
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Entity Type | Organization
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Legal Business Name | LIFESTYLE CHANGES WELLNESS CENTER
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 3535 MARVIN D LOVE FWY STE 8
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City | DALLAS
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State | TX
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Zip | 75224-4411
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Country | US
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Telephone | 214-755-1489
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 OLD HICKORY TRL APT 18103
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City | DESOTO
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State | TX
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Zip | 75115-2294
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Country | US
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Telephone | 214-766-0440
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. CORI MOORING
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Credential | DC
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Telephone | 214-755-1489
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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 |
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License Number State |
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