Provider Demographics
NPI:1699264143
Name:MY LIFE WELL ADJUSTED LLC
Entity type:Organization
Organization Name:MY LIFE WELL ADJUSTED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-307-7513
Mailing Address - Street 1:164 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357-4036
Mailing Address - Country:US
Mailing Address - Phone:207-737-2482
Mailing Address - Fax:207-737-2484
Practice Address - Street 1:268 STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5417
Practice Address - Country:US
Practice Address - Phone:207-307-7513
Practice Address - Fax:207-307-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132180000Medicaid