Provider Demographics
NPI:1316498470
Name:LIFE STARTS HERE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:LIFE STARTS HERE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-703-2479
Mailing Address - Street 1:5 SHAPLEIGH ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904
Mailing Address - Country:US
Mailing Address - Phone:207-703-2479
Mailing Address - Fax:
Practice Address - Street 1:5 SHAPLEIGH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1452
Practice Address - Country:US
Practice Address - Phone:207-703-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty