| Organization Name: | LIFESTYLE WELLNESS CENTER OF THE PALM BEACHES LLC |
| NPI Number: | 1104071943 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDY M WALDRON (BILLING ADMIN.) |
| Mailing Address: | 11903 Southern Blvd Ste 110 Royal Palm Beach |
| State: | FL US |
| Postal Code: | 334117644 |
| Phone Number: | 5613862213 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2008 |
| NPI Last Update Date: | 11/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |