Organization Active NPI

Lifestyle Chiropractic PLLC

  • Chiropractor
  • Denton, TX
National Provider Identifier
1063777522
Registry record updated Dec 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6387 Issued in TX
Legal business name
LIFESTYLE CHIROPRACTIC PLLC
Practice address
721 W Hickory St
Denton, TX 76201-4044
Phone
(940) 387-0405
Fax
(940) 383-2966
NPI assigned
Jul 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Todd Lee Porter, D.C.NPI 1093700270
Title
Sole MBR
Phone
(940) 387-0405

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 6387 TX Primary

Addresses

Primary practice location

721 W Hickory St
Denton, TX 76201-4044

Mailing address

2317 W University Dr Ste B5
Denton, TX 76201-1699
Phone (940) 387-0405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130521000201 TX Part B Supplier - Clinic/Group Practice 6204074818 Receives reassigned benefits from 1 practitioner
Practice locations: Denton, TX

National Provider Directory

National Provider Directory

Locations

2317 W University Dr
Ste B5
Denton, TX 76201
Phone (214) 555-9999

721 W Hickory St
Denton, TX 76201
Phone (940) 387-0405

2317 W University Dr
#B5
Denton, TX 76201
Phone (817) 387-0405

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513555200000",
    "number": "1063777522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2317 W UNIVERSITY DR STE B5",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762011699",
            "telephone_number": "940-387-0405",
            "fax_number": "940-383-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 W HICKORY ST",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762014044",
            "telephone_number": "940-387-0405",
            "fax_number": "940-383-2966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-11",
        "last_updated": "2017-12-18",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "940-387-0405",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "6387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.