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General NPI Number Information
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NPI Number | 1790120772
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Entity Type | Organization
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Legal Business Name | LIFETIME CHIROPRACTIC & WELLNESS, INC.
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 7951 KATY FWY STE S
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City | HOUSTON
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State | TX
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Zip | 77024-1947
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Country | US
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Telephone | 713-681-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 7951 KATY FWY STE S
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City | HOUSTON
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State | TX
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Zip | 77024-1947
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Country | US
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Telephone | 713-681-5483
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES DAMON HAYNES JR.
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Credential | D.C.
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Telephone | 713-681-5483
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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 | 11961
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License Number State | TX
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