Organization
LIFESTYLE WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLI G SMITH (MANAGING MEMBER)
(417) 223-4103
Entity
Organization
Contact information
Practice address
307 MAIN STREET, PINEVILLE, MO 64856
(417) 223-4103
Mailing address
PO BOX 37, PINEVILLE, MO 64856-0037
(417) 223-4103
(417) 223-4102
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
003822
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2106860001
BLUE CROSS BLUE SHIELD
MO
Enumeration date
02/26/2007
Last updated
08/22/2020
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