Provider Demographics
NPI:1104040179
Name:LIFETIME HEALTH & WELLNESS CENTER SC
Entity type:Organization
Organization Name:LIFETIME HEALTH & WELLNESS CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SCHENING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-717-3400
Mailing Address - Street 1:101 S MCLEAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1830
Mailing Address - Country:US
Mailing Address - Phone:847-717-3400
Mailing Address - Fax:847-255-7945
Practice Address - Street 1:101 S MCLEAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177
Practice Address - Country:US
Practice Address - Phone:847-717-3400
Practice Address - Fax:847-255-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 363LF0000X, 111N00000X, 111N00000X, 363LF0000X
IL038007411111N00000X
IL038012387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532114OtherBLUE CROSS BLUE SHIELD
10641623OtherCAQH
ILU47569Medicare UPIN