Provider Demographics
NPI:1063819712
Name:LIVING WELL CHIROPRACTIC & MASSAGE INC.
Entity Type:Organization
Organization Name:LIVING WELL CHIROPRACTIC & MASSAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-842-4929
Mailing Address - Street 1:363 TORMEY LN NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2895
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:363 TORMEY LN NE
Practice Address - Street 2:SUITE 210
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2895
Practice Address - Country:US
Practice Address - Phone:206-842-4929
Practice Address - Fax:206-842-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60503164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty