Provider Demographics
NPI:1689927428
Name:L.I.V.N. CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:L.I.V.N. CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-338-3691
Mailing Address - Street 1:925 S KERR AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4335
Mailing Address - Country:US
Mailing Address - Phone:910-338-3691
Mailing Address - Fax:910-338-3691
Practice Address - Street 1:925 S KERR AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4335
Practice Address - Country:US
Practice Address - Phone:910-338-3691
Practice Address - Fax:910-338-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty