Provider Demographics
NPI:1972757698
Name:LIVE WELL CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LIVE WELL CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-922-7008
Mailing Address - Street 1:4902 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PLYMOUTH
Mailing Address - State:ID
Mailing Address - Zip Code:83655-5255
Mailing Address - Country:US
Mailing Address - Phone:208-278-3764
Mailing Address - Fax:
Practice Address - Street 1:3163 E FAIRVIEW AVE
Practice Address - Street 2:#155
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8098
Practice Address - Country:US
Practice Address - Phone:972-922-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty