MEDICARE: LIFESTYLE ELEVATED PC

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	6122	CO

General Provider Information

NPI Number	:	1861985723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE ELEVATED PC

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1056
Country	:	US
Telephone Number	:	720-940-4603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 S 21ST ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4204
Country	:	US
Telephone Number	:	719-632-4225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY CHRISTOPHERSON
Credential	:	DC
Telephone Number	:	720-940-4603

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	12/02/2024

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Directions to “LIFESTYLE ELEVATED PC ” Practice Location

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