Provider Demographics
NPI:1891881009
Name:HEALTHY LIVING CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:HEALTHY LIVING CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-9355
Mailing Address - Street 1:6998 N US HIGHWAY 27
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-8906
Mailing Address - Country:US
Mailing Address - Phone:352-735-9355
Mailing Address - Fax:352-732-9356
Practice Address - Street 1:6998 N US HIGHWAY 27
Practice Address - Street 2:SUITE 110
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-8906
Practice Address - Country:US
Practice Address - Phone:352-735-9355
Practice Address - Fax:352-732-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6913111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55217YMedicare ID - Type Unspecified
FLU53303Medicare UPIN