Provider Demographics
NPI:1275781262
Name:LIVING WELL CHIROPRACTIC
Entity Type:Organization
Organization Name:LIVING WELL CHIROPRACTIC
Other - Org Name:LIVING WELL CHIROPRACTIC, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHANCE
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-450-9898
Mailing Address - Street 1:2113 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3737
Mailing Address - Country:US
Mailing Address - Phone:501-450-9898
Mailing Address - Fax:501-358-4353
Practice Address - Street 1:2113 PRINCE ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3737
Practice Address - Country:US
Practice Address - Phone:501-450-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1690111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty