Provider Demographics
NPI:1578710075
Name:LIVE WELL FAMILY CHIROPRACTIC CENTERS, LLC
Entity Type:Organization
Organization Name:LIVE WELL FAMILY CHIROPRACTIC CENTERS, LLC
Other - Org Name:LIVE WELL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-728-2101
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-0363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 N STATESVILLE RD
Practice Address - Street 2:SUITE G
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6076
Practice Address - Country:US
Practice Address - Phone:704-728-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456087AOtherMEDICARE GROUP PROVIDER/SUPPLIER PTAN