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General NPI Number Information
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NPI Number | 1962734889
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Entity Type | Organization
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Legal Business Name | LIFETIME WELLNESS CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 528 N. STATE ST
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City | SHELLEY
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State | ID
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Zip | 83274-1154
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Country | US
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Telephone | 208-357-0333
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Fax | 208-357-2299
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Provider Business Mailing Address
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Address Line | 528 N. STATE ST
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City | SHELLEY
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State | ID
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Zip | 83274-1154
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Country | US
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Telephone | 208-357-0333
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Fax | 208-357-2299
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRENNAN T WILLIAMS
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Credential | D.C.
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Telephone | 208-552-5555
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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 | CHIA-1397
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License Number State | ID
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