| Lifelong Wellness Clinic Pllc | |
|
711 W Main St Eastland TX 76448-2534 | |
| (254) 629-1100 | |
| (254) 629-1104 |
| Full Name | Lifelong Wellness Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 711 W Main St, Eastland, Texas |
| Authorized Official Name and Position | Christopher Tidroski (OWNER) |
| Authorized Official Contact | 2546291100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifelong Wellness Clinic Pllc 711 W Main St Eastland TX 76448-2534 Ph: (254) 629-1100 | Lifelong Wellness Clinic Pllc 711 W Main St Eastland TX 76448-2534 Ph: (254) 629-1100 |
| NPI Number | 1114205812 |
|---|---|
| Provider Enumeration Date | 07/28/2011 |
| Last Update Date | 10/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114205812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N2319 (Texas) | Primary |
| 208000000X | Pediatrics | P0309 (Texas) | Secondary |
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