Healthcare Provider Details

I. General information

NPI: 1205637980
Provider Name (Legal Business Name): LIFETIME CHIROPRACTIC AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 STANLEY RD STE 2
WINTHROP ME
04364-3348
US

IV. Provider business mailing address

662 STANLEY RD STE 2
WINTHROP ME
04364-3348
US

V. Phone/Fax

Practice location:
  • Phone: 207-395-5052
  • Fax: 207-395-5077
Mailing address:
  • Phone: 207-395-5052
  • Fax: 207-395-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE CHRISTIANSON
Title or Position: OFFICE MANAGER/OWNER
Credential: CNS
Phone: 207-395-5052