Provider Demographics
NPI:1376117853
Name:LIFESTYLE WELLNESS
Entity type:Organization
Organization Name:LIFESTYLE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMELIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-900-0238
Mailing Address - Street 1:224 NORWICH CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1134
Mailing Address - Country:US
Mailing Address - Phone:973-900-0238
Mailing Address - Fax:
Practice Address - Street 1:290 MADISON AVE STE 3A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7401
Practice Address - Country:US
Practice Address - Phone:973-590-2448
Practice Address - Fax:973-590-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty