Provider Demographics
NPI:1578923603
Name:LIVE WELL CHIROPRACTIC OF WNY, PC
Entity Type:Organization
Organization Name:LIVE WELL CHIROPRACTIC OF WNY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-839-9355
Mailing Address - Street 1:3963 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3401
Mailing Address - Country:US
Mailing Address - Phone:716-839-9355
Mailing Address - Fax:716-247-6616
Practice Address - Street 1:3963 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3401
Practice Address - Country:US
Practice Address - Phone:716-839-9355
Practice Address - Fax:716-247-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty