Provider Demographics
NPI:1497021869
Name:LIVING WELL PLLC
Entity Type:Organization
Organization Name:LIVING WELL PLLC
Other - Org Name:LIVING WELL PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-410-8550
Mailing Address - Street 1:PO BOX 910544
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0544
Mailing Address - Country:US
Mailing Address - Phone:859-410-8550
Mailing Address - Fax:859-223-0642
Practice Address - Street 1:771 CORPORATE DRIVE
Practice Address - Street 2:SUITE 610
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5440
Practice Address - Country:US
Practice Address - Phone:859-410-8550
Practice Address - Fax:859-223-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33755174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty