Provider Demographics
NPI:1538478433
Name:LIVE WELL FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LIVE WELL FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-918-8777
Mailing Address - Street 1:4000 HILTON PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3352
Mailing Address - Country:US
Mailing Address - Phone:505-918-8777
Mailing Address - Fax:
Practice Address - Street 1:3301 SOUTHERN BLVD SE
Practice Address - Street 2:SUITE 105
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2085
Practice Address - Country:US
Practice Address - Phone:505-891-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1799261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center