Provider Demographics
NPI:1558409367
Name:LIVING WELL MEDICAL CENTER
Entity Type:Organization
Organization Name:LIVING WELL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JARROD
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-346-4865
Mailing Address - Street 1:828 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2010
Mailing Address - Country:US
Mailing Address - Phone:304-346-4865
Mailing Address - Fax:304-346-4868
Practice Address - Street 1:828 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2010
Practice Address - Country:US
Practice Address - Phone:304-346-4865
Practice Address - Fax:304-346-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630092000Medicaid
WV9318651Medicare PIN