MEDICARE: LIFESTYLE CHIROPRACTIC AND WELLNESS LLC

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	111NI0013X	Independent Medical Examiner Chiropractor	2012012018	MO

General Provider Information

NPI Number	:	1558613877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE CHIROPRACTIC AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1735 WALNUT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1315
Country	:	US
Telephone Number	:	816-216-8778
Fax Number	:	816-817-3280

Provider Business Practice Location Address
First Line	:	1735 WALNUT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1315
Country	:	US
Telephone Number	:	816-216-8778
Fax Number	:	816-817-3280

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. SHELLEY LOWMAN
Credential	:	DC
Telephone Number	:	816-216-8778

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	11/02/2012

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