Provider Demographics
NPI:1033350657
Name:HEALTHY LIVING FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HEALTHY LIVING FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-822-0218
Mailing Address - Street 1:2202 EASTLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2202 EASTLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3585
Practice Address - Country:US
Practice Address - Phone:309-662-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty