MEDICARE: LIFESTYLE FOUNDATIONS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1164164646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE FOUNDATIONS INC

Provider Business Mailing Address
First Line	:	155 PRINTERS PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-6101
Country	:	US
Telephone Number	:	719-574-5500
Fax Number	:	719-471-9053

Provider Business Practice Location Address
First Line	:	155 PRINTERS PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-6101
Country	:	US
Telephone Number	:	719-574-5500
Fax Number	:	719-471-9053

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. ERICA CLAUDINE WILKERSON
Credential	:
Telephone Number	:	719-574-5500

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “LIFESTYLE FOUNDATIONS INC ” Practice Location

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