The Lifestyle Clinic LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

THE LIFESTYLE CLINIC LLC

Practice address

10935 SE 177TH PL Ste 201
Summerfield, FL 34491-8971

Phone

(352) 693-2681

NPI assigned

Sep 7, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Anderson Carlos Goncalves, L.AC., D.A.C.MNPI 1891021804

Title

Acupuncture Physcian - Owner

Phone

(352) 693-2681

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.

• Anderson Carlos Goncalves, AP, DACM

  • Acupuncturist
  • Summerfield, FL
  • NPI 1891021804
  NPD Authorized official

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

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1861278467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10935 SE 177TH PL STE 201",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344918971",
            "telephone_number": "352-693-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10935 SE 177TH PL STE 201",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344918971",
            "telephone_number": "352-693-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFESTYLE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-07",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "GONCALVES",
        "authorized_official_first_name": "ANDERSON",
        "authorized_official_middle_name": "CARLOS",
        "authorized_official_title_or_position": "ACUPUNCTURE PHYSCIAN - OWNER",
        "authorized_official_telephone_number": "352-693-2681",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.AC., D.A.C.M"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Summerfield, FL
• Providers in Summerfield, FL by specialty
• Acupuncturist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.