Provider Demographics
NPI:1871974287
Name:LIFESTYLE CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:LIFESTYLE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAMBURELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-255-8000
Mailing Address - Street 1:1796 HINDS RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8261
Mailing Address - Country:US
Mailing Address - Phone:732-255-8000
Mailing Address - Fax:732-255-4580
Practice Address - Street 1:1796 HINDS ROAD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8175
Practice Address - Country:US
Practice Address - Phone:732-255-8000
Practice Address - Fax:732-255-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00394700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ663586Medicare UPIN