Provider Demographics
NPI:1124475033
Name:LIFESTREAM CLINIC
Entity type:Organization
Organization Name:LIFESTREAM CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-259-9336
Mailing Address - Street 1:1830 SE PRINCETON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-4826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1830 SE PRINCETON DR
Practice Address - Street 2:SUITE D
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-4826
Practice Address - Country:US
Practice Address - Phone:515-259-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty