Provider Demographics
NPI:1699953943
Name:LIFEETIME WELLNESS LIMITED
Entity type:Organization
Organization Name:LIFEETIME WELLNESS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:HOLT
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-876-5500
Mailing Address - Street 1:701 W MCNELLY RD
Mailing Address - Street 2:STE 9
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9159
Mailing Address - Country:US
Mailing Address - Phone:479-876-5500
Mailing Address - Fax:
Practice Address - Street 1:701 W MCNELLY RD
Practice Address - Street 2:STE 9
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-9159
Practice Address - Country:US
Practice Address - Phone:479-876-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty