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General NPI Number Information
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NPI Number | 1861985723
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Entity Type | Organization
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Legal Business Name | LIFESTYLE ELEVATED PC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1410 S 21ST ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-4204
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Country | US
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Telephone | 719-632-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 595 CHAPEL HILLS DR STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1056
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Country | US
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Telephone | 720-940-4603
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY CHRISTOPHERSON
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Credential | DC
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Telephone | 720-940-4603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6122
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License Number State | CO
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