Provider Demographics
NPI:1750816013
Name:LIVE SIMPLY CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:LIVE SIMPLY CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:LIVE SIMPLY CHIROPRATIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-550-4402
Mailing Address - Street 1:805 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 S VAN DYKE RD STE A
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9604
Practice Address - Country:US
Practice Address - Phone:989-550-4402
Practice Address - Fax:989-623-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty