Provider Demographics
NPI:1972774313
Name:LIQUID REI, LLC
Entity Type:Organization
Organization Name:LIQUID REI, LLC
Other - Org Name:HEALING HAND PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-246-1234
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1708
Mailing Address - Country:US
Mailing Address - Phone:615-246-1234
Mailing Address - Fax:
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1708
Practice Address - Country:US
Practice Address - Phone:615-246-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty