Healthcare Provider Details

I. General information

NPI: 1548912066
Provider Name (Legal Business Name): NORTHERN COMFORT WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ELM ST STE 1
GORHAM ME
04038-1506
US

IV. Provider business mailing address

8 ELM ST STE 1
GORHAM ME
04038-1506
US

V. Phone/Fax

Practice location:
  • Phone: 207-604-2236
  • Fax: 207-805-6470
Mailing address:
  • Phone: 207-604-2236
  • Fax: 207-805-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDEE R STYNCHULA
Title or Position: OWNER, PROVIDER
Credential: ND
Phone: 207-604-2236