NPIMap

Organization Active NPI

Lifetime Wellness Chiropractic PLLC

  • Chiropractor
  • Shelley, ID
National Provider Identifier
1962734889
Registry record updated Nov 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1397 Issued in ID
Legal business name
LIFETIME WELLNESS CHIROPRACTIC PLLC
Practice address
528 N. State St
Shelley, ID 83274-1154
Phone
(208) 357-0333
Fax
(208) 357-2299
NPI assigned
Feb 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2025

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

Authorized official

Name
Dr. Brennan T Williams, D.C.NPI 1811228521
Title
Member
Phone
(208) 552-5555

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 CHIA-1397 ID Primary

Addresses

Primary practice location

528 N. State St
Shelley, ID 83274-1154

Mailing address

528 N. State St
Shelley, ID 83274-1154
Phone (208) 357-0333

Other identifiers 1

IdentifierTypeStateIssuer
1962734889MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100303001114 ID Part B Supplier - Clinic/Group Practice 6406991256 Receives reassigned benefits from 3 practitioners
Practice locations: Shelley, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763683200000",
    "number": "1962734889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 N. STATE ST",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741154",
            "telephone_number": "208-357-0333",
            "fax_number": "208-357-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 N. STATE ST",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741154",
            "telephone_number": "208-357-0333",
            "fax_number": "208-357-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME WELLNESS CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRENNAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-552-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962734889",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; 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.