Organization Active NPI

Lovers Lane Wellness Center LLC

  • Chiropractor
  • Dallas, TX
National Provider Identifier
1295065118
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
10106 Issued in TX
Legal business name
LOVERS LANE WELLNESS CENTER LLC
Practice address
12800 Preston Rd.
Ste. 201
Dallas, TX 75230
Phone
(214) 351-2299
Fax
(214) 351-1122
NPI assigned
Dec 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Authorized official

Name
Kathleen Tisko
Title
Managing Partner
Phone
(214) 766-0589

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 10106 TX Primary

Addresses

Primary practice location

12800 Preston Rd.
Ste. 201
Dallas, TX 75230

Mailing address

3844 Martha LN
Dallas, TX 75229-6126
Phone (214) 351-3904

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100716000413 TX Part B Supplier - Clinic/Group Practice 9931231594 Receives reassigned benefits from 1 practitioner
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1262044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1295065118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3844 MARTHA LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752296126",
            "telephone_number": "214-351-3904",
            "fax_number": "214-351-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 PRESTON RD.",
            "address_2": "STE. 201",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75230",
            "telephone_number": "214-351-2299",
            "fax_number": "214-351-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOVERS LANE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-29",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "TISKO",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "214-766-0589"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "10106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.