Liferestore MD USA NC1 LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

LIFERESTORE MD USA NC1 LLC

Practice address

1427 Military Cutoff Rd Ste 140
Wilmington, NC 28403-3692

Phone

(214) 494-8121

NPI assigned

May 5, 2021

Organization subpart

No

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

Authorized official

Name

Bob Olovsson

Title

Coo

Phone

(214) 494-8121

Specialties & licenses 1

Addresses

Other names 2

• RestoreDOC MD Doing business as
• liferestore md usa llc Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1417530593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 GASTON AVE STE 140",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461523",
            "telephone_number": "214-494-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 MILITARY CUTOFF RD STE 140",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284033692",
            "telephone_number": "214-494-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFERESTORE MD USA NC1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "OLOVSSON",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "214-494-8121"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BOB@RESTOREDOC.COM",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1427 Military Cutoff Rd Ste 140",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284033692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "RestoreDOC MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "liferestore md usa llc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lifecare Supportive Medicine Incorporated
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• Lifeline Chiropractic and Natural Medicine PC
• Lifeline Treatment Center
• Lifeline Treatment Center
• Lifesource Accountability Inc
• Lifesource of North Carolina
• Lifesource Prime Inc
• Lifetime Resources, Inc.
• Lifetime Resources, Inc.

• Multi-Specialty Clinic/Center in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.