Provider Demographics
NPI:1871761874
Name:LIFELINE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:LIFELINE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-630-9800
Mailing Address - Street 1:2525 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-6001
Mailing Address - Country:US
Mailing Address - Phone:610-630-9800
Mailing Address - Fax:610-630-9002
Practice Address - Street 1:2525 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-6001
Practice Address - Country:US
Practice Address - Phone:610-630-9800
Practice Address - Fax:610-630-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006422L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA830329OtherBC/BS
PA2011329OtherHIGHMARK GRP
PA2016082000OtherIBX
ST830329Medicare PIN