Provider Demographics
NPI:1104019629
Name:HEALTHY LIVING CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEALTHY LIVING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:WINFRED
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-853-2027
Mailing Address - Street 1:2119 HASLETT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8669
Mailing Address - Country:US
Mailing Address - Phone:517-853-2027
Mailing Address - Fax:517-853-0832
Practice Address - Street 1:2119 HASLETT RD
Practice Address - Street 2:SUITE A
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8669
Practice Address - Country:US
Practice Address - Phone:517-853-2027
Practice Address - Fax:517-853-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C315720OtherBLUE CROSS BLUE SHIELD
MI950C315720OtherBLUE CROSS BLUE SHIELD