Provider Demographics
NPI:1275882995
Name:LIVE FOR WELLNESS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:LIVE FOR WELLNESS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-960-2425
Mailing Address - Street 1:3417 SHELBY RAY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5895
Mailing Address - Country:US
Mailing Address - Phone:843-556-6000
Mailing Address - Fax:
Practice Address - Street 1:3417 SHELBY RAY CT
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5895
Practice Address - Country:US
Practice Address - Phone:843-556-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty