Provider Demographics
NPI:1225284342
Name:LIVE WELL CHIROPRACTIC SPA AND ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:LIVE WELL CHIROPRACTIC SPA AND ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:ALISE
Authorized Official - Last Name:BECKER-PUKLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-746-8150
Mailing Address - Street 1:7975 STONE CREEK DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4614
Mailing Address - Country:US
Mailing Address - Phone:952-746-8150
Mailing Address - Fax:952-746-8152
Practice Address - Street 1:7975 STONE CREEK DR
Practice Address - Street 2:SUITE 20
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4614
Practice Address - Country:US
Practice Address - Phone:952-746-8150
Practice Address - Fax:952-746-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty