Provider Demographics
NPI:1124487194
Name:LIFETIME WELLNESS CHIROPRACTIC OF WESTERN NEW YORK
Entity type:Organization
Organization Name:LIFETIME WELLNESS CHIROPRACTIC OF WESTERN NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEGAN-IACCHETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-471-5919
Mailing Address - Street 1:1580 ELMWOOD AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3620
Mailing Address - Country:US
Mailing Address - Phone:585-471-5919
Mailing Address - Fax:
Practice Address - Street 1:1580 ELMWOOD AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3620
Practice Address - Country:US
Practice Address - Phone:585-471-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012270111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty