Provider Demographics
NPI:1295076057
Name:ENLIVEN PROF LLC
Entity type:Organization
Organization Name:ENLIVEN PROF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-336-1188
Mailing Address - Street 1:412 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6901
Mailing Address - Country:US
Mailing Address - Phone:605-336-1188
Mailing Address - Fax:605-336-2677
Practice Address - Street 1:412 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6901
Practice Address - Country:US
Practice Address - Phone:605-336-1188
Practice Address - Fax:605-336-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty