Provider Demographics
NPI:1417441510
Name:LIVING WELL PAIN CENTER
Entity Type:Organization
Organization Name:LIVING WELL PAIN CENTER
Other - Org Name:ACCIDENT REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-261-8355
Mailing Address - Street 1:3721 116TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8428
Mailing Address - Country:US
Mailing Address - Phone:360-805-8252
Mailing Address - Fax:360-805-8052
Practice Address - Street 1:3721 116TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8428
Practice Address - Country:US
Practice Address - Phone:360-805-8252
Practice Address - Fax:360-805-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty