Provider Demographics
NPI:1376585133
Name:LIVING WELL CHIROPRACTIC INC. PC.
Entity Type:Organization
Organization Name:LIVING WELL CHIROPRACTIC INC. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-332-1024
Mailing Address - Street 1:1412 E YELM AV
Mailing Address - Street 2:C101
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597
Mailing Address - Country:US
Mailing Address - Phone:360-458-7533
Mailing Address - Fax:
Practice Address - Street 1:1412 E YELM AV
Practice Address - Street 2:C101
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597
Practice Address - Country:US
Practice Address - Phone:360-458-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2022-08-29
Deactivation Date:2022-07-11
Deactivation Code:
Reactivation Date:2022-08-29
Provider Licenses
StateLicense IDTaxonomies
WACH00034456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty