Provider Demographics
NPI:1063777522
Name:LIFESTYLE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:LIFESTYLE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-387-0405
Mailing Address - Street 1:2317 W UNIVERSITY DR STE B5
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1699
Mailing Address - Country:US
Mailing Address - Phone:940-387-0405
Mailing Address - Fax:940-383-2966
Practice Address - Street 1:721 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4044
Practice Address - Country:US
Practice Address - Phone:940-387-0405
Practice Address - Fax:940-383-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty