Michiana Wellness and Longevity Clinic, Inc.

Primary specialty

Internist ChiropractorTaxonomy code 111NI0900X

License

08002006A Issued in IN

Legal business name

MICHIANA WELLNESS AND LONGEVITY CLINIC, INC.

Practice address

605 W Edison Rd
Suite G
Mishawaka, IN 46545-8823

Phone

(574) 258-4444

Fax

(574) 258-4445

NPI assigned

Aug 29, 2006

Last updated

Mar 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. William James Lyden, D.C., DABCI, DCBCNNPI 1710900469

Title

President & Ceo

Phone

(574) 258-4444

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William James Lyden, D.C.

  • Chiropractor
  • Mishawaka, IN
  • NPI 1710900469
  Authorized official Same address or phone

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1306954466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 W EDISON RD",
            "address_2": "SUITE G",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465458823",
            "telephone_number": "574-258-4444",
            "fax_number": "574-258-4445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 W EDISON RD",
            "address_2": "SUITE G",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465458823",
            "telephone_number": "574-258-4444",
            "fax_number": "574-258-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA WELLNESS AND LONGEVITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "LYDEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "574-258-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., DABCI, DCBCN"
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "IN",
            "license": "08002006A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internist Chiropractor in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Internist Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.