Provider Demographics
NPI:1598907842
Name:LIVE WELL HEALTH, PC
Entity Type:Organization
Organization Name:LIVE WELL HEALTH, PC
Other - Org Name:NELSON CHIROPRACTIC & FUNCTIONAL NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:NTP
Authorized Official - Phone:503-855-4465
Mailing Address - Street 1:PO BOX 2415
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-2415
Mailing Address - Country:US
Mailing Address - Phone:503-855-4465
Mailing Address - Fax:888-201-5353
Practice Address - Street 1:7100 SW HAMPTON ST STE 121A
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8390
Practice Address - Country:US
Practice Address - Phone:503-855-4465
Practice Address - Fax:888-201-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1695111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty