Provider Demographics
NPI:1366025793
Name:LIVE WELL ALABAMA, LLC
Entity Type:Organization
Organization Name:LIVE WELL ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-377-3655
Mailing Address - Street 1:30941 MILL LN STE B
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5457
Mailing Address - Country:US
Mailing Address - Phone:251-459-0098
Mailing Address - Fax:844-861-4341
Practice Address - Street 1:30941 MILL LN STE B
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5457
Practice Address - Country:US
Practice Address - Phone:251-459-0098
Practice Address - Fax:844-861-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty