MEDICARE: LIFETIME CHIROPRACTIC PLLC

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	3938	NC

General Provider Information

NPI Number	:	1346585254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3154
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-3154
Country	:	US
Telephone Number	:	919-797-0428
Fax Number	:	919-797-0448

Provider Business Practice Location Address
First Line	:	1014 LAMOND AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27701-2021
Country	:	US
Telephone Number	:	919-797-0428
Fax Number	:	919-797-0448

Authorized Official
Title or Position	:	OWNER-OPERATOR
Name	:	DR. LATISHA WRIGHT
Credential	:
Telephone Number	:	919-797-0428

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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