Provider Demographics
NPI:1407162134
Name:HEALTHY LIVING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:HEALTHY LIVING AND WELLNESS, LLC
Other - Org Name:HEALTHY LIVING AND WELLNESS, MARISSA BUNKER D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-455-7832
Mailing Address - Street 1:1620 TWEED ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1423
Mailing Address - Country:US
Mailing Address - Phone:301-455-7832
Mailing Address - Fax:
Practice Address - Street 1:1620 TWEED ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1423
Practice Address - Country:US
Practice Address - Phone:301-455-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty