Provider Demographics
NPI:1821444613
Name:LIVE WELL MEDICINE, LLC
Entity Type:Organization
Organization Name:LIVE WELL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, MOM
Authorized Official - Phone:717-832-4111
Mailing Address - Street 1:203 W CARACAS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1567
Mailing Address - Country:US
Mailing Address - Phone:717-832-4111
Mailing Address - Fax:
Practice Address - Street 1:203 W CARACAS AVE STE 203
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1567
Practice Address - Country:US
Practice Address - Phone:717-832-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty