Provider Demographics
NPI:1346585254
Name:LIFETIME CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:LIFETIME CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-797-0428
Mailing Address - Street 1:PO BOX 3154
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-3154
Mailing Address - Country:US
Mailing Address - Phone:919-797-0428
Mailing Address - Fax:919-797-0448
Practice Address - Street 1:1014 LAMOND AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2021
Practice Address - Country:US
Practice Address - Phone:919-797-0428
Practice Address - Fax:919-797-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty