Provider Demographics
NPI:1245399435
Name:LIVING WELL CHIROPRACTIC PLC
Entity type:Organization
Organization Name:LIVING WELL CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-408-0440
Mailing Address - Street 1:1135 S WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-8401
Mailing Address - Country:US
Mailing Address - Phone:321-408-0440
Mailing Address - Fax:321-577-0200
Practice Address - Street 1:1135 S WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-8401
Practice Address - Country:US
Practice Address - Phone:321-408-0440
Practice Address - Fax:321-577-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1891765988OtherINDIVIDUAL NPI NUMBER
FL1891765988OtherINDIVIDUAL NPI NUMBER
FLV04327Medicare UPIN