MEDICARE: MY LIFE WELL ADJUSTED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CR912	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699264143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY LIFE WELL ADJUSTED LLC

Provider Business Mailing Address
First Line	:	164 MAIN ST STE 3
Second Line	:
City	:	RICHMOND
State	:	ME
Zip	:	04357-4036
Country	:	US
Telephone Number	:	207-737-2482
Fax Number	:	207-737-2484

Provider Business Practice Location Address
First Line	:	268 STATE ST STE 1
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-5417
Country	:	US
Telephone Number	:	207-307-7513
Fax Number	:	207-307-7553

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY SLOCUM
Credential	:	DC
Telephone Number	:	207-307-7513

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	09/27/2018

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Directions to “MY LIFE WELL ADJUSTED LLC ” Practice Location

Language	Start Address	Practice Location

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