Organization
LIFE STYLE ENHANCEMENT CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN T WILDER D.C. (OWNER)
(706) 837-0405
Entity
Organization
Contact information
Practice address
3206 W POINT RD, LAGRANGE, GA 30240-7545
(706) 837-0405
(800) 648-5256
Mailing address
3206 W POINT RD, LAGRANGE, GA 30240-7545
(706) 837-0405
(800) 648-5256
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5191
GA
Other
Enumeration date
06/24/2010
Last updated
07/07/2010
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