Provider Demographics
NPI:1215621883
Name:LCM MIND BODY CORPORATION
Entity type:Organization
Organization Name:LCM MIND BODY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-705-0201
Mailing Address - Street 1:92 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7639
Mailing Address - Country:US
Mailing Address - Phone:610-705-0201
Mailing Address - Fax:
Practice Address - Street 1:92 KEMP RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7639
Practice Address - Country:US
Practice Address - Phone:610-705-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty