Provider Demographics
NPI:1154553725
Name:LIFETIME WELLNESS LLC
Entity type:Organization
Organization Name:LIFETIME WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:770-509-9717
Mailing Address - Street 1:3901 ROSWELL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8809
Mailing Address - Country:US
Mailing Address - Phone:770-509-9717
Mailing Address - Fax:770-509-8796
Practice Address - Street 1:3901 ROSWELL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8809
Practice Address - Country:US
Practice Address - Phone:770-509-9717
Practice Address - Fax:770-509-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty