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Organization
LIFELONG WELLNESS CLINIC PLLC
Active
Organization
LIFELONG WELLNESS CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TIDROSKI D.O. (OWNER)
(254) 629-1100
Entity
Organization
Contact information
Practice address
711 W MAIN ST, EASTLAND, TX 76448-2534
(254) 629-1100
(254) 629-1104
Mailing address
711 W MAIN ST, EASTLAND, TX 76448-2534
(254) 629-1100
(254) 629-1104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N2319
TX
208000000X
Pediatrics Physician
P0309
TX
Other
Enumeration date
07/28/2011
Last updated
10/23/2013
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