Provider Demographics
NPI:1285294116
Name:LIFETIME CHIROPRACTIC INC
Entity type:Organization
Organization Name:LIFETIME CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-363-2200
Mailing Address - Street 1:433 BROADWAY STE E
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3401
Mailing Address - Country:US
Mailing Address - Phone:857-363-2202
Mailing Address - Fax:857-472-7373
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3425
Practice Address - Country:US
Practice Address - Phone:857-363-2200
Practice Address - Fax:857-472-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation