MEDICARE: LIFESTYLE CHIROPRACTIC HEALTH CENTER

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	:	1790956274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE CHIROPRACTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	54820 MOUND RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-1705
Country	:	US
Telephone Number	:	568-677-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	54820 MOUND RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-1705
Country	:	US
Telephone Number	:	568-677-1616
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	GINA LOUISE RUBENSTEIN
Credential	:
Telephone Number	:	586-677-1616

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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Directions to “LIFESTYLE CHIROPRACTIC HEALTH CENTER ” Practice Location

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